Provider Demographics
NPI:1164448825
Name:ASSILI, AMIR DARIUS (DPM)
Entity Type:Individual
Prefix:DR
First Name:AMIR
Middle Name:DARIUS
Last Name:ASSILI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16220 S FREDERICK AVE
Mailing Address - Street 2:SUITE 427
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-4039
Mailing Address - Country:US
Mailing Address - Phone:301-948-2995
Mailing Address - Fax:301-948-6056
Practice Address - Street 1:16220 S FREDERICK AVE
Practice Address - Street 2:SUITE 427
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-4039
Practice Address - Country:US
Practice Address - Phone:301-948-2995
Practice Address - Fax:301-948-6056
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01355213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD407559500Medicaid
MD407559500Medicaid