Healthcare Provider Details

I. General information

NPI: 1841284213
Provider Name (Legal Business Name): AMJAD MIAN RASUL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 05/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1160 VARNUM ST., N.E. #114
WASHINGTON DC
20017-2110
US

IV. Provider business mailing address

17770 CHIPPING CT
OLNEY MD
20832-1626
US

V. Phone/Fax

Practice location:
  • Phone: 202-526-8966
  • Fax: 202-526-6025
Mailing address:
  • Phone: 301-570-7813
  • Fax: 202-526-6025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberD0025802
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD12149
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: