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General NPI Number Information
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NPI Number | 1417400417
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Entity Type | Organization
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Legal Business Name | HOME BASED PRIMARY CARE OF DC INC.
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Dates
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Enumeration Date | 07/27/2016
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Last Update Date | 07/27/2016
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Provider Practice Location Address
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Address Line | 10110 MOLECULAR DRIVE SUITE 114
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City | ROCKVILLE
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State | MD
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Zip | 20850
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Country | US
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Telephone | 301-343-6505
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Fax |
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Provider Business Mailing Address
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Address Line | 10110 MOLECULAR DRIVE SUITE 114
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City | ROCKVILLE
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State | MD
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Zip | 20850
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Country | US
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Telephone | 301-343-6505
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANUSHIRAVAN DADGAR
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Credential | D.O
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Telephone | 301-343-6505
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | H0051280
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License Number State | MD
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