Healthcare Provider Details

I. General information

NPI: 1609257187
Provider Name (Legal Business Name): TARANA NEKZAD D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2015
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 ST PATRICK'S DRIVE
WALDORF MD
20603-4572
US

IV. Provider business mailing address

PO BOX 640
HOLLYWOOD MD
20636-0640
US

V. Phone/Fax

Practice location:
  • Phone: 301-373-7900
  • Fax: 301-705-7628
Mailing address:
  • Phone: 301-373-7900
  • Fax: 301-373-6900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberH0092432
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberH0092432
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: