Healthcare Provider Details

I. General information

NPI: 1407218480
Provider Name (Legal Business Name): NANCY P YOUSSEFI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2016
Last Update Date: 03/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7350 VAN DUSEN RD STE B20
LAUREL MD
20707-5239
US

IV. Provider business mailing address

7350 VAN DUSEN RD STE B20
LAUREL MD
20707-5239
US

V. Phone/Fax

Practice location:
  • Phone: 301-317-6281
  • Fax: 301-317-5695
Mailing address:
  • Phone: 301-317-6281
  • Fax: 301-317-5695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberD0023835
License Number StateMD

VIII. Authorized Official

Name: MRS. ELISABETH TCHOKOKO
Title or Position: BILLING MANAGER
Credential:
Phone: 301-317-6281