Individual
DR. NADER TAVAKOLI-JALILI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9500 MEDICAL CENTER DR # 3230-F, LARGO, MD 20774-3701
(301) 352-7118
Mailing address
626C ADMIRAL DR, # 235, ANNAPOLIS, MD 21401-2151
(301) 352-7118
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
D0041978
MD
207QA0505X
Adult Medicine Physician
D0041978
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
305791700
—
MD
01
—
B181
BCBS PROV #
MD
Enumeration date
06/07/2007
Last updated
08/27/2021
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