Healthcare Provider Details

I. General information

NPI: 1487444600
Provider Name (Legal Business Name): ATEEYEH ATEFAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2025
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5316 NEW DESIGN RD
FREDERICK MD
21703-7102
US

IV. Provider business mailing address

9 MARCUS CT
ROCKVILLE MD
20850-2749
US

V. Phone/Fax

Practice location:
  • Phone: 301-698-9411
  • Fax:
Mailing address:
  • Phone: 240-620-5703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number30278
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number30278
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: