Provider Demographics
NPI:1245403849
Name:MY MED CLINIC PA
Entity Type:Organization
Organization Name:MY MED CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FARZANA
Authorized Official - Middle Name:
Authorized Official - Last Name:AJMAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-698-3245
Mailing Address - Street 1:19731 EXECUTIVE PARK CIR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-2642
Mailing Address - Country:US
Mailing Address - Phone:301-698-3245
Mailing Address - Fax:301-698-3246
Practice Address - Street 1:19731 EXECUTIVE PARK CIR
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-2642
Practice Address - Country:US
Practice Address - Phone:301-698-3245
Practice Address - Fax:301-698-3246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-04
Last Update Date:2013-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0065301207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty