Provider Demographics
NPI:1467603191
Name:ALLERGY, ASTHMA AND IMMUNOLOGY CENTER
Entity Type:Organization
Organization Name:ALLERGY, ASTHMA AND IMMUNOLOGY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHABNAM
Authorized Official - Middle Name:
Authorized Official - Last Name:FOROUGHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-315-1500
Mailing Address - Street 1:10110 MOLECULAR DR
Mailing Address - Street 2:SUITE 209
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-7539
Mailing Address - Country:US
Mailing Address - Phone:301-315-1500
Mailing Address - Fax:301-315-2545
Practice Address - Street 1:10110 MOLECULAR DR
Practice Address - Street 2:SUITE 209
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-7539
Practice Address - Country:US
Practice Address - Phone:301-315-1500
Practice Address - Fax:301-315-2545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-30
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD006571207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty