Individual
DR. ATA MOTAMEDI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
17904 GEORGIA AVE, SUITE # 304, OLNEY, MD 20832-2239
(301) 924-2790
(301) 924-1631
Mailing address
PO BOX 309, OLNEY, MD 20830-0309
(301) 924-2790
(301) 924-1631
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
D0063999
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0033
CAREFIRST BCBS
DC
01
—
1194549
AETNA HMO
MD
01
—
132355
JHHC
MD
05
—
409839100
—
MD
01
—
5901543
AETNA PPO
MD
01
—
65112701
CAREFIRST BCBS
MD
01
—
P00307411
RR MEDICARE
MD
Enumeration date
09/29/2005
Last updated
12/27/2012
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