Provider Demographics
NPI:1346423571
Name:DUS FAMILY MEDICAL PRACTICE, LLC
Entity Type:Organization
Organization Name:DUS FAMILY MEDICAL PRACTICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SAMIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-313-0425
Mailing Address - Street 1:7525 GREENWAY CENTER DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-3509
Mailing Address - Country:US
Mailing Address - Phone:301-313-0425
Mailing Address - Fax:301-313-0435
Practice Address - Street 1:7525 GREENWAY CENTER DR
Practice Address - Street 2:SUITE 105
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-3509
Practice Address - Country:US
Practice Address - Phone:301-313-0425
Practice Address - Fax:301-313-0435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-11
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0063394207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD9745569OtherCIGNA
DCK543OtherCAREFIRST DC
MD407632000Medicaid
MD660BDUOtherCAREFIRST BCBS
MDG02071Medicare PIN