Provider Demographics
NPI:1386089373
Name:KESHAV PRIMARY CARE, LLC
Entity type:Organization
Organization Name:KESHAV PRIMARY CARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:KIRAN
Authorized Official - Middle Name:U
Authorized Official - Last Name:KESHAV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-455-6545
Mailing Address - Street 1:7525 GREENWAY CENTER DR STE 210
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-3525
Mailing Address - Country:US
Mailing Address - Phone:301-358-1134
Mailing Address - Fax:301-686-8586
Practice Address - Street 1:7525 GREENWAY CENTER DR STE 210
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-3525
Practice Address - Country:US
Practice Address - Phone:301-358-1134
Practice Address - Fax:301-686-8586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-03
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD57652207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty