Provider Demographics
NPI:1427245745
Name:JARIWALA HEALTH SERVICES LLC
Entity type:Organization
Organization Name:JARIWALA HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MANISHA
Authorized Official - Middle Name:J
Authorized Official - Last Name:JARIWALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-885-3811
Mailing Address - Street 1:11637 TERRACE DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-3706
Mailing Address - Country:US
Mailing Address - Phone:301-885-3811
Mailing Address - Fax:301-885-2177
Practice Address - Street 1:11637 TERRACE DR
Practice Address - Street 2:SUITE 103
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-3706
Practice Address - Country:US
Practice Address - Phone:301-885-3811
Practice Address - Fax:301-885-2177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0057999207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD126PMedicare PIN