Healthcare Provider Details

I. General information

NPI: 1962319947
Provider Name (Legal Business Name): URBANA PRIMARY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3546 WORTHINGTON BLVD UNIT 301
URBANA MD
21704-7126
US

IV. Provider business mailing address

PO BOX 34202
BETHESDA MD
20827-0202
US

V. Phone/Fax

Practice location:
  • Phone: 301-979-9772
  • Fax: 301-355-0076
Mailing address:
  • Phone: 301-979-9772
  • Fax: 301-355-0076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SASSAN TAGHIZADEHMOGHADDAM
Title or Position: PROVIDER/OWNER
Credential:
Phone: 301-356-3017