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General NPI Number Information
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NPI Number | 1316286032
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Entity Type | Organization
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Legal Business Name | PRIME PEDIATRICS, LLC
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Dates
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Enumeration Date | 02/01/2013
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Last Update Date | 02/01/2013
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Provider Practice Location Address
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Address Line | 845 QUINCE ORCHARD BLVD STE B
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City | GAITHERSBURG
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State | MD
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Zip | 20878-1676
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Country | US
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Telephone | 301-977-2440
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Fax | 301-977-4752
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Provider Business Mailing Address
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Address Line | 845 QUINCE ORCHARD BLVD STE B
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City | GAITHERSBURG
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State | MD
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Zip | 20878-1676
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Country | US
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Telephone | 301-977-2440
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Fax | 301-977-4752
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Authorized Official
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Title or Position | OWNER
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Name | DR. FARNOUSH JAMALI
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Credential | M.D.
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Telephone | 301-977-2440
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number | D0058375
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License Number State | MD
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