Healthcare Provider Details

I. General information

NPI: 1043689201
Provider Name (Legal Business Name): OXON HILL PRIMARY MEDICINE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2015
Last Update Date: 09/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6196 OXON HILL RD SUITE 250
OXON HILL MD
20745-3100
US

IV. Provider business mailing address

PO BOX 2510
LAUREL MD
20709-2510
US

V. Phone/Fax

Practice location:
  • Phone: 301-567-8880
  • Fax:
Mailing address:
  • Phone: 301-498-9495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD0070134
License Number StateMD

VIII. Authorized Official

Name: DR. KAVEH SADEGHI
Title or Position: OWNER
Credential: MD
Phone: 301-498-9495