Provider Demographics
NPI:1285738633
Name:PHAROAN, BASHAR (MD)
Entity type:Individual
Prefix:DR
First Name:BASHAR
Middle Name:
Last Name:PHAROAN
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:PO BOX 452
Mailing Address - Street 2:
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21094-0452
Mailing Address - Country:US
Mailing Address - Phone:410-241-1670
Mailing Address - Fax:410-252-4929
Practice Address - Street 1:4744 RIDGE ROAD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21236
Practice Address - Country:US
Practice Address - Phone:410-241-1670
Practice Address - Fax:410-252-4929
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0019637174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty