NPIMap

Organization Active NPI

Pantea Tamjidi MD PC

  • Procedural Dermatology Physician
  • Chevy Chase, MD
National Provider Identifier
1841489804
Registry record updated Jul 20, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Procedural Dermatology PhysicianTaxonomy code 207NS0135X
License
D0063624 Issued in MD
Legal business name
PANTEA TAMJIDI MD PC
Practice address
5454 Wisconsin Ave
Suite 1045
Chevy Chase, MD 20815-6917
Phone
(301) 652-4828
Fax
(301) 652-2070
NPI assigned
Oct 16, 2007
Last updated
Jul 20, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 20, 2010

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

Authorized official

Name
Dr. Pantea Tamjidi, M.D.
Title
President
Phone
(301) 652-4828

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Procedural Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207NS0135X D0063624 MD Primary

Addresses

Primary practice location

5454 Wisconsin Ave
Suite 1045
Chevy Chase, MD 20815-6917

Mailing address

5454 Wisconsin Ave
Suite 1045
Chevy Chase, MD 20815-6917
Phone (301) 652-4828

Other names 1

  • TAMJIDI & FARBOUDMANESCH Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060303000351 DC Part B Supplier - Clinic/Group Practice 0547276255 Receives reassigned benefits from 11 practitioners
Practice locations: Bethesda, MD; Vienna, VA

National Provider Directory

National Provider Directory

Locations

1160 Varnum St NE
Ste 202
Washington, DC 20017
Phone (202) 269-1495

2 Wisconsin Cir
Ste 100
Chevy Chase, MD 20815

2 Wisconsin Cir
Ste 1000
Chevy Chase, MD 20815
Phone (301) 652-4828

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1192492800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1279584000000",
    "number": "1841489804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5454 WISCONSIN AVE",
            "address_2": "SUITE 1045",
            "city": "CHEVY CHASE",
            "state": "MD",
            "postal_code": "208156917",
            "telephone_number": "301-652-4828",
            "fax_number": "301-652-2070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5454 WISCONSIN AVE",
            "address_2": "SUITE 1045",
            "city": "CHEVY CHASE",
            "state": "MD",
            "postal_code": "208156917",
            "telephone_number": "301-652-4828",
            "fax_number": "301-652-2070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PANTEA TAMJIDI MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-16",
        "last_updated": "2010-07-20",
        "status": "A",
        "authorized_official_last_name": "TAMJIDI",
        "authorized_official_first_name": "PANTEA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "301-652-4828",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207NS0135X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "MD",
            "license": "D0063624",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "TAMJIDI & FARBOUDMANESCH",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Chevy Chase, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.