Provider Demographics
NPI:1972748192
Name:SUBURBAN NEPHROLOGY ASSOCIATES LLC
Entity type:Organization
Organization Name:SUBURBAN NEPHROLOGY ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BABAK
Authorized Official - Middle Name:
Authorized Official - Last Name:RAZI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:240-965-7955
Mailing Address - Street 1:4404 QUEENSBURY ROAD
Mailing Address - Street 2:SUITE #100
Mailing Address - City:RIVERDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20737
Mailing Address - Country:US
Mailing Address - Phone:301-779-1949
Mailing Address - Fax:301-699-1703
Practice Address - Street 1:12200 ANNAPOLIS RD STE 233
Practice Address - Street 2:
Practice Address - City:GLENN DALE
Practice Address - State:MD
Practice Address - Zip Code:20769-9182
Practice Address - Country:US
Practice Address - Phone:240-965-7955
Practice Address - Fax:301-699-1703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-03
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty