Provider Demographics
NPI:1417546953
Name:TELE HEALTH PRACTICE
Entity Type:Organization
Organization Name:TELE HEALTH PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:AVEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SAED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-985-6253
Mailing Address - Street 1:9513 BLAKE LN APT 204
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-1716
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9513 BLAKE LN APT 204
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-1716
Practice Address - Country:US
Practice Address - Phone:443-985-6253
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-11
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA058649751Medicaid