Healthcare Provider Details

I. General information

NPI: 1346565462
Provider Name (Legal Business Name): ASAD KARAMALI BANDEALY MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2010
Last Update Date: 06/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6103 BALTIMORE AVE STE T1
RIVERDALE PARK MD
20737-1966
US

IV. Provider business mailing address

2300 18TH ST NW APT 308
WASHINGTON DC
20009-1898
US

V. Phone/Fax

Practice location:
  • Phone: 301-277-2779
  • Fax:
Mailing address:
  • Phone: 312-810-4116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD77994
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: