Provider Demographics
NPI:1417315813
Name:OLDE TOWNE PRIMARY CARE LLC
Entity Type:Organization
Organization Name:OLDE TOWNE PRIMARY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RASHA
Authorized Official - Middle Name:BAFI
Authorized Official - Last Name:SALEEM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:202-316-4407
Mailing Address - Street 1:317 E DIAMOND AVE
Mailing Address - Street 2:C1
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-3093
Mailing Address - Country:US
Mailing Address - Phone:240-246-1111
Mailing Address - Fax:
Practice Address - Street 1:317 E DIAMOND AVE
Practice Address - Street 2:C1
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-3093
Practice Address - Country:US
Practice Address - Phone:240-246-1111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-01
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care