Individual provider Active NPI

Maryam Esfahani Zareh

  • Physician Assistant
  • Gaithersburg, MD
National Provider Identifier
1083254387
Registry record updated May 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0110007101 Issued in VA
Practice address
18516 Gingerbread LN
Gaithersburg, MD 20877-3534
Phone
(240) 380-6507
NPI assigned
Jan 14, 2020
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X C0007431 MD
Physician Assistant 363A00000X 0110007101 VA Primary

Addresses

Primary practice location

18516 Gingerbread LN
Gaithersburg, MD 20877-3534

Mailing address

18516 Gingerbread LN
Gaithersburg, MD 20877-3534
Phone (240) 380-6507

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200603002227 DC Practitioner - Physician Assistant 5193146900 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Privia Medical Group, LLCGroup PAC ID 4385682061, 1,522 clinicians

Practice addresses (Care Compare)

6136 Brandon Ave
Springfield, VA 22150-2610
Phone (703) 866-3131

9470 Annapolis Rd
Suite 309
Lanham, MD 20706-3022
Phone (202) 832-1800

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
C0007431MDMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Privia Medical Group, LLC CurrentSince May 1, 2020 Accepting new patients
Privia Medical Group, LLC CurrentSince May 1, 2020 Accepting new patients

Locations

9470 Annapolis Rd
Ste 309
Lanham, MD 20706
Phone (202) 832-1800

6136 Brandon Ave
Springfield, VA 22150
Phone (703) 866-3131

Interoperability endpoints

  • Direct secure messaging: maryam.esfahani.zareh.1@8042.direct.athenahealth.com

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1578960000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1590105600000",
    "number": "1083254387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18516 GINGERBREAD LN",
            "city": "GAITHERSBURG",
            "state": "MD",
            "postal_code": "208773534",
            "telephone_number": "240-380-6507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18516 GINGERBREAD LN",
            "city": "GAITHERSBURG",
            "state": "MD",
            "postal_code": "208773534",
            "telephone_number": "240-380-6507"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ESFAHANI ZAREH",
        "first_name": "MARYAM",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-01-14",
        "last_updated": "2020-05-22",
        "certification_date": "2020-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MD",
            "license": "C0007431",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VA",
            "license": "0110007101",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gaithersburg, MD

Sources for this page

Verify at the official NPI Registry.