Provider Demographics
NPI:1235782665
Name:PRADEEP SIMLOTE MD PC
Entity Type:Organization
Organization Name:PRADEEP SIMLOTE MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PRADEEP
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMLOTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-737-4995
Mailing Address - Street 1:PO BOX 459
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:20636-0459
Mailing Address - Country:US
Mailing Address - Phone:301-737-4995
Mailing Address - Fax:301-737-4996
Practice Address - Street 1:41680 MISS BESSIE DR STE 203
Practice Address - Street 2:
Practice Address - City:LEONARDTOWN
Practice Address - State:MD
Practice Address - Zip Code:20650-2964
Practice Address - Country:US
Practice Address - Phone:301-737-4995
Practice Address - Fax:301-475-3323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-24
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
655BPOtherCAREFIRST
K440OtherCAREFIRST
MD475310100Medicaid