Organization
NADER TAVAKOLI PA INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NADER TAVAKOLI-JALILI MD (PRESIDENT)
(301) 352-7118
Entity
Organization
Contact information
Practice address
9500 MEDICAL CENTER DRIVE SUITE 230-F, LARGO, MD 20774
(301) 352-7118
(301) 352-7779
Mailing address
626 ADMIRAL DR, SUITE C #235, ANNAPOLIS, MD 21401-2151
(301) 352-7118
(301) 352-7779
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207QA0505X
Adult Medicine Physician
D41978
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
305791700
—
MD
Enumeration date
09/20/2006
Last updated
08/25/2021
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