Healthcare Provider Details

I. General information

NPI: 1811936271
Provider Name (Legal Business Name): DAVOUD ASSILI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 07/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9470 ANNAPOLIS RD SUITE 402
LANHAM MD
20706-3025
US

IV. Provider business mailing address

9470 ANNAPOLIS RD SUITE 402
LANHAM MD
20706-3025
US

V. Phone/Fax

Practice location:
  • Phone: 301-459-7700
  • Fax: 301-459-7536
Mailing address:
  • Phone: 301-459-7700
  • Fax: 301-459-7536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberD15406
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: