Healthcare Provider Details

I. General information

NPI: 1154995496
Provider Name (Legal Business Name): JOUDEH BISHARA FREIJ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2021
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 RESEARCH BLVD STE 115
ROCKVILLE MD
20850-6544
US

IV. Provider business mailing address

2301 RESEARCH BLVD STE 115
ROCKVILLE MD
20850-6544
US

V. Phone/Fax

Practice location:
  • Phone: 301-990-1664
  • Fax: 301-990-0471
Mailing address:
  • Phone: 301-990-0137
  • Fax: 301-990-0471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0101403
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: