Healthcare Provider Details

I. General information

NPI: 1598186256
Provider Name (Legal Business Name): TA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2013
Last Update Date: 12/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7676 NEW HAMPSHIRE AVE STE 418
TAKOMA PARK MD
20912-7516
US

IV. Provider business mailing address

7676 NEW HAMPSHIRE AVE STE 418
TAKOMA PARK MD
20912-7516
US

V. Phone/Fax

Practice location:
  • Phone: 301-431-0160
  • Fax: 301-431-0163
Mailing address:
  • Phone: 301-431-0160
  • Fax: 301-431-0163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. MARIA JOSE ALLAHYARI
Title or Position: CEO
Credential:
Phone: 301-431-0160