Provider Demographics
NPI:1699243584
Name:CAREFIRST MEDICAL GROUP
Entity type:Organization
Organization Name:CAREFIRST MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HARESH
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:BOGHARA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-391-1158
Mailing Address - Street 1:9353 ELAM RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75217-4181
Mailing Address - Country:US
Mailing Address - Phone:214-391-1158
Mailing Address - Fax:214-398-0212
Practice Address - Street 1:9353 ELAM RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75217-4181
Practice Address - Country:US
Practice Address - Phone:214-391-1158
Practice Address - Fax:214-398-0212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-08
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty