Provider Demographics
NPI:1437219094
Name:MOTAMEDI AND ASSOCIATES INTERNAL MEDICINE,PC
Entity Type:Organization
Organization Name:MOTAMEDI AND ASSOCIATES INTERNAL MEDICINE,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ATA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOTAMEDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-924-2790
Mailing Address - Street 1:PO BOX 309
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20830-0309
Mailing Address - Country:US
Mailing Address - Phone:301-824-2790
Mailing Address - Fax:301-924-1631
Practice Address - Street 1:17904 GEORGIA AVE
Practice Address - Street 2:SUITE 304
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-2239
Practice Address - Country:US
Practice Address - Phone:301-924-2790
Practice Address - Fax:301-924-1631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD063999207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G02539Medicare PIN