Provider Demographics
NPI:1043689201
Name:OXON HILL PRIMARY MEDICINE PC
Entity Type:Organization
Organization Name:OXON HILL PRIMARY MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAVEH
Authorized Official - Middle Name:
Authorized Official - Last Name:SADEGHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-498-9495
Mailing Address - Street 1:PO BOX 2510
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20709-2510
Mailing Address - Country:US
Mailing Address - Phone:301-498-9495
Mailing Address - Fax:
Practice Address - Street 1:6196 OXON HILL RD
Practice Address - Street 2:SUITE 250
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-3100
Practice Address - Country:US
Practice Address - Phone:301-567-8880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRIMARY MEDICINE MANAGEMENT LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-09-17
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0070134207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty