Provider Demographics
NPI:1306310073
Name:JASSI PRIMARY CARE PA
Entity type:Organization
Organization Name:JASSI PRIMARY CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JASSI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-410-3161
Mailing Address - Street 1:325 HOSPITAL DR STE 205
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-5807
Mailing Address - Country:US
Mailing Address - Phone:443-410-3161
Mailing Address - Fax:443-410-3199
Practice Address - Street 1:325 HOSPITAL DR STE 205
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-5807
Practice Address - Country:US
Practice Address - Phone:443-410-3161
Practice Address - Fax:443-410-3199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-16
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD68100400Medicaid