Healthcare Provider Details

I. General information

NPI: 1790765246
Provider Name (Legal Business Name): JAGDEEP SINGH OBHRAI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 02/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 24TH ST NW SUITE 17
WASHINGTON DC
20037-2543
US

IV. Provider business mailing address

4915 AUBURN AVE SUITE 200
BETHESDA MD
20814-2636
US

V. Phone/Fax

Practice location:
  • Phone: 202-337-7660
  • Fax: 202-625-6018
Mailing address:
  • Phone: 301-907-3939
  • Fax: 301-656-3943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number228359
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: