Provider Demographics
NPI:1396025730
Name:JAFAR NAZEMIAN M.D. P.A.
Entity type:Organization
Organization Name:JAFAR NAZEMIAN M.D. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JAFAR
Authorized Official - Middle Name:
Authorized Official - Last Name:NAZEMIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-567-8880
Mailing Address - Street 1:6196 OXON HILL RD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:OXON HILL
Mailing Address - State:MD
Mailing Address - Zip Code:20745-3100
Mailing Address - Country:US
Mailing Address - Phone:301-567-8880
Mailing Address - Fax:301-839-7026
Practice Address - Street 1:6196 OXON HILL RD
Practice Address - Street 2:SUITE 250
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-3100
Practice Address - Country:US
Practice Address - Phone:301-567-8880
Practice Address - Fax:301-839-7026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-17
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0009162207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD009961900Medicaid
MDB93796Medicare UPIN
MD009961900Medicaid