Provider Demographics
NPI:1427330463
Name:FIRST CLINIC, LLC
Entity type:Organization
Organization Name:FIRST CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KALA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAHI
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:301-765-9255
Mailing Address - Street 1:9800 FALLS RD
Mailing Address - Street 2:STE 3
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-3999
Mailing Address - Country:US
Mailing Address - Phone:301-765-9255
Mailing Address - Fax:301-299-3838
Practice Address - Street 1:9800 FALLS RD
Practice Address - Street 2:STE 3
Practice Address - City:POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20854-3999
Practice Address - Country:US
Practice Address - Phone:301-765-9255
Practice Address - Fax:301-299-3838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR114087363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDR114087OtherMARYLAND STATE LICENSE