Provider Demographics
NPI:1457823981
Name:KASRA ADHAM MD
Entity Type:Organization
Organization Name:KASRA ADHAM MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:KASRA
Authorized Official - Middle Name:
Authorized Official - Last Name:ADHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-899-8900
Mailing Address - Street 1:4467 OLD BRANCH AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:TEMPLE HILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20748-1854
Mailing Address - Country:US
Mailing Address - Phone:301-899-8900
Mailing Address - Fax:
Practice Address - Street 1:4467 OLD BRANCH AVE
Practice Address - Street 2:
Practice Address - City:TEMPLE HILLS
Practice Address - State:MD
Practice Address - Zip Code:20748-1854
Practice Address - Country:US
Practice Address - Phone:301-899-8900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-21
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty