Healthcare Provider Details

I. General information

NPI: 1386920007
Provider Name (Legal Business Name): NEERAJ HARRY PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2011
Last Update Date: 01/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3414 OLANDWOOD CT
OLNEY MD
20832-1384
US

IV. Provider business mailing address

3414 OLANDWOOD CT
OLNEY MD
20832-1384
US

V. Phone/Fax

Practice location:
  • Phone: 301-774-0500
  • Fax: 301-774-7338
Mailing address:
  • Phone: 301-774-0500
  • Fax: 301-774-7338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberC0004687
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberC0004687
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: