Organization
PRIME PEDIATRICS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FARNOUSH JAMALI M.D. (OWNER)
(301) 977-2440
Entity
Organization
Contact information
Practice address
845 QUINCE ORCHARD BLVD STE B, GAITHERSBURG, MD 20878-1676
(301) 977-2440
(301) 977-4752
Mailing address
845 QUINCE ORCHARD BLVD STE B, GAITHERSBURG, MD 20878-1676
(301) 977-2440
(301) 977-4752
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
D0058375
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0400041 00
—
MD
Enumeration date
02/01/2013
Last updated
02/01/2013
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