Provider Demographics
NPI:1164667192
Name:PRIMECARE MED LLC
Entity Type:Organization
Organization Name:PRIMECARE MED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PANKAJ
Authorized Official - Middle Name:
Authorized Official - Last Name:TALWAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-762-3030
Mailing Address - Street 1:PO BOX 60620
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20859-0620
Mailing Address - Country:US
Mailing Address - Phone:301-762-3030
Mailing Address - Fax:301-762-3998
Practice Address - Street 1:50 W EDMONSTON DR
Practice Address - Street 2:SUITE 401
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-1228
Practice Address - Country:US
Practice Address - Phone:301-762-3030
Practice Address - Fax:301-762-3998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-04
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD213065701OtherOWNER SS#