MEDICARE: DMV ALLERGY AND ASTHMA CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207K00000X	Allergy & Immunology Physician

General Provider Information

NPI Number	:	1184508004
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DMV ALLERGY AND ASTHMA CENTER LLC

Provider Business Mailing Address
First Line	:	112 THOMAS JOHNSON DR STE 210
Second Line	:
City	:	FREDERICK
State	:	MD
Zip	:	21702-4970
Country	:	US
Telephone Number	:	301-370-2434
Fax Number	:	301-444-5535

Provider Business Practice Location Address
First Line	:	112 THOMAS JOHNSON DR STE 210
Second Line	:
City	:	FREDERICK
State	:	MD
Zip	:	21702-4970
Country	:	US
Telephone Number	:	301-370-2434
Fax Number	:	301-444-5535

Authorized Official
Title or Position	:	OWNER
Name	:	PAVAN NATARAJ
Credential	:	MD
Telephone Number	:	703-994-6655

Provider Enumeration Date	:	08/04/2025
Last Update Date	:	08/04/2025

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