Organization
OUTREACH MD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EHSAN ABDESHAHIAN M.D. (MEDICAL DIRECTOR)
(405) 306-0384
Entity
Organization
Contact information
Practice address
4201 NORTHVIEW DR, SUITE 501, BOWIE, MD 20716-2604
(410) 220-1111
Mailing address
2124 4TH AVE S, BIRMINGHAM, AL 35233-2204
(205) 279-8981
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0714704
—
MD
Enumeration date
04/26/2016
Last updated
08/18/2016
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