MEDICARE: WASHINGTON CONCIERGE MEDICAL GROUP, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1265181655
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WASHINGTON CONCIERGE MEDICAL GROUP, LLC

Provider Business Mailing Address
First Line	:	5530 WISCONSIN AVE STE 914
Second Line	:
City	:	CHEVY CHASE
State	:	MD
Zip	:	20815-4330
Country	:	US
Telephone Number	:	301-256-8070
Fax Number	:	833-937-2803

Provider Business Practice Location Address
First Line	:	5530 WISCONSIN AVE STE 914
Second Line	:
City	:	CHEVY CHASE
State	:	MD
Zip	:	20815-4330
Country	:	US
Telephone Number	:	301-256-8070
Fax Number	:	833-937-2803

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ALI SANAI
Credential	:	MD
Telephone Number	:	301-256-8070

Provider Enumeration Date	:	03/22/2022
Last Update Date	:	03/23/2022

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