# NADER TAVAKOLI PA INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1346348075
- **Authorized official:** DR. NADER TAVAKOLI-JALILI MD (PRESIDENT)
- **Authorized official phone:** (301) 352-7118

## Contact information

- **Practice address:** 9500 MEDICAL CENTER DRIVE SUITE 230-F, LARGO, MD 20774
- **Practice address phone:** (301) 352-7118
- **Practice address fax:** (301) 352-7779
- **Mailing address:** 626 ADMIRAL DR, SUITE C \#235, ANNAPOLIS, MD 21401-2151
- **Mailing address phone:** (301) 352-7118
- **Mailing address fax:** (301) 352-7779

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 207QA0505X | Adult Medicine Physician | D41978 | MD | — |

## Other

- **Enumeration date:** 09/20/2006
- **Last updated:** 08/25/2021