Provider Demographics
NPI:1699960773
Name:NASREEN M KANGO
Entity type:Organization
Organization Name:NASREEN M KANGO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NASREEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:KANGO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-270-7606
Mailing Address - Street 1:14841 DUFIEF DR
Mailing Address - Street 2:
Mailing Address - City:NORTH POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20878-2522
Mailing Address - Country:US
Mailing Address - Phone:301-270-7606
Mailing Address - Fax:
Practice Address - Street 1:17B FIRSTFIELD RD
Practice Address - Street 2:SUITE 207
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-1775
Practice Address - Country:US
Practice Address - Phone:301-270-7606
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-11
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD409PMedicare PIN
DCG02494Medicare PIN