Healthcare Provider Details

I. General information

NPI: 1699960773
Provider Name (Legal Business Name): NASREEN M KANGO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2007
Last Update Date: 09/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17B FIRSTFIELD RD SUITE 207
GAITHERSBURG MD
20878-1775
US

IV. Provider business mailing address

14841 DUFIEF DR
NORTH POTOMAC MD
20878-2522
US

V. Phone/Fax

Practice location:
  • Phone: 301-270-7606
  • Fax:
Mailing address:
  • Phone: 301-270-7606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. NASREEN M KANGO
Title or Position: OWNER
Credential: M.D.
Phone: 301-270-7606