Provider Demographics
NPI:1316985005
Name:BAHRI, DALED (MD)
Entity type:Individual
Prefix:
First Name:DALED
Middle Name:
Last Name:BAHRI
Suffix:
Gender:F
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 1826
Mailing Address - Street 2:
Mailing Address - City:COROZAL
Mailing Address - State:PR
Mailing Address - Zip Code:00783-1826
Mailing Address - Country:US
Mailing Address - Phone:787-859-4377
Mailing Address - Fax:787-859-0396
Practice Address - Street 1:7 CALLE GANDARA
Practice Address - Street 2:
Practice Address - City:COROZAL
Practice Address - State:PR
Practice Address - Zip Code:00783-1984
Practice Address - Country:US
Practice Address - Phone:787-859-4377
Practice Address - Fax:787-859-0396
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7773174400000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR29565Medicare ID - Type Unspecified
PRD-32347Medicare UPIN