MEDICARE: DR. CYRUS NEMATI M.D.

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	207RN0300X	Nephrology Physician	D25725	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538278460
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CYRUS NEMATI M.D.

Provider Business Mailing Address
First Line	:	12441 BACALL LN
Second Line	:
City	:	POTOMAC
State	:	MD
Zip	:	20854-1026
Country	:	US
Telephone Number	:	301-590-9797
Fax Number	:	301-899-3309

Provider Business Practice Location Address
First Line	:	3611 BRANCH AVE
Second Line	:	SUITE 407
City	:	TEMPLE HILLS
State	:	MD
Zip	:	20748-1242
Country	:	US
Telephone Number	:	301-899-3388
Fax Number	:	301-899-3309

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	12/21/2009

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