MEDICARE: PREMIER HEALTH EXPRESS AND ADVANCED DIAGNOSTICS INC

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1831705748
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER HEALTH EXPRESS AND ADVANCED DIAGNOSTICS INC

Provider Business Mailing Address
First Line	:	9710 PATUXENT WOODS DR STE 200
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21046-3458
Country	:	US
Telephone Number	:	443-899-9525
Fax Number	:

Provider Business Practice Location Address
First Line	:	5474 SAINT BARNABAS RD
Second Line	:
City	:	OXON HILL
State	:	MD
Zip	:	20745-3622
Country	:	US
Telephone Number	:	443-899-9525
Fax Number	:

Authorized Official
Title or Position	:	MD/OWNER
Name	:	SAMUEL NOKURI
Credential	:	MD
Telephone Number	:	443-899-9525

Provider Enumeration Date	:	09/17/2020
Last Update Date	:	05/13/2021

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