Provider Demographics
NPI:1285602052
Name:BAHHADY, IMAD J (MD)
Entity type:Individual
Prefix:
First Name:IMAD
Middle Name:J
Last Name:BAHHADY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 WASHINGTON ST
Mailing Address - Street 2:2400
Mailing Address - City:TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02780-2491
Mailing Address - Country:US
Mailing Address - Phone:508-824-7282
Mailing Address - Fax:508-824-7285
Practice Address - Street 1:72 WASHINGTON ST STE 2100
Practice Address - Street 2:
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-2470
Practice Address - Country:US
Practice Address - Phone:508-824-7282
Practice Address - Fax:508-824-7285
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA209555207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2091364Medicaid
MAA37903Medicare ID - Type Unspecified
MA2091364Medicaid