Nader Tavakoli PA Inc

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

NADER TAVAKOLI PA INC

Practice address

9500 Medical Center Drive Suite 230-F
Largo, MD 20774

Phone

(301) 352-7118

Fax

(301) 352-7779

NPI assigned

Sep 20, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Nader Tavakoli-Jalili, MD

Title

President

Phone

(301) 352-7118

Specialties & licenses 2

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629849600000",
    "number": "1346348075",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "626 ADMIRAL DR",
            "address_2": "SUITE C #235",
            "city": "ANNAPOLIS",
            "state": "MD",
            "postal_code": "214012151",
            "telephone_number": "301-352-7118",
            "fax_number": "301-352-7779"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9500 MEDICAL CENTER DRIVE SUITE 230-F",
            "city": "LARGO",
            "state": "MD",
            "postal_code": "20774",
            "telephone_number": "301-352-7118",
            "fax_number": "301-352-7779"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NADER TAVAKOLI PA INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2021-08-25",
        "certification_date": "2021-08-09",
        "status": "A",
        "authorized_official_last_name": "TAVAKOLI-JALILI",
        "authorized_official_first_name": "NADER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "301-352-7118",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207QA0505X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine, Adult Medicine",
            "state": "MD",
            "license": "D41978",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "305791700",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.