Individual ProviderShadpour DemehriRadiologyAllopathic & Osteopathic PhysiciansPractice Address600 N Wolfe St, Baltimore, MD 21287-0005(410) 955-6500(410) 933-6423PECOS EnrollmentBased on the most recent information from CMS, provider Shadpour Demehri is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1609003128Provider TypeIndividualFull NameDemehri, ShadpourTitleDr.CredentialM.D.GenderMaleSole ProprietorNoEnumeration Date6/11/2009Last Updated3/17/2022Contact InformationPractice LocationPractice Address600 N Wolfe St, Baltimore, MD 21287-0005Phone(410) 955-6500FaxUnlisted FaxMailing LocationMailing Address6201 Greenleigh Avenue 2nd Floor, Baltimore, MD 21264-2004Phone(410) 933-6423Fax(410) 933-1390Provider TaxonomiesCodeDescriptionLicenseCode2085R0202XPrimaryDescriptionRadiologyAllopathic & Osteopathic PhysiciansLicenseD74595MarylandProvider IdentifiersIDDescriptionIssuerIDD74595DescriptionOtherIssuerMARYLAND LICENSEMarylandID056876700DescriptionMedicaidIssuerUnlistedMaryland