Healthcare Provider Details

I. General information

NPI: 1285220830
Provider Name (Legal Business Name): EXPRESS CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2020
Last Update Date: 09/20/2021
Certification Date: 09/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

724 MAIDEN CHOICE LN STE 201
CATONSVILLE MD
21228-5962
US

IV. Provider business mailing address

11321 MEGAN LYNN CT
MARRIOTTSVILLE MD
21104-1658
US

V. Phone/Fax

Practice location:
  • Phone: 410-650-4121
  • Fax: 866-948-8535
Mailing address:
  • Phone: 410-650-4121
  • Fax: 266-948-8535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: JAZIBEH QURESHI
Title or Position: OWNER
Credential: MD
Phone: 410-650-4121