Provider Demographics
NPI:1356465553
Name:TELELE, JIMA (MD)
Entity Type:Individual
Prefix:
First Name:JIMA
Middle Name:
Last Name:TELELE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3710 RIVIERA ST
Mailing Address - Street 2:SUITE 1D
Mailing Address - City:TEMPLE HILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20748-1719
Mailing Address - Country:US
Mailing Address - Phone:301-423-4551
Mailing Address - Fax:301-423-4553
Practice Address - Street 1:12164 CENTRAL AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:MITCHELLVILLE
Practice Address - State:MD
Practice Address - Zip Code:20721-1944
Practice Address - Country:US
Practice Address - Phone:301-218-9223
Practice Address - Fax:240-544-0120
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MDD0046895207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDH71547Medicare UPIN