Provider Demographics
NPI:1598083917
Name:JAMALODEEN BAKSH MD LLC
Entity Type:Organization
Organization Name:JAMALODEEN BAKSH MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMALODEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKSH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-942-0991
Mailing Address - Street 1:3951 FERRARA DR
Mailing Address - Street 2:CONNECTICUT BELAIR MEDICAL PARK
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-4709
Mailing Address - Country:US
Mailing Address - Phone:301-942-0991
Mailing Address - Fax:301-942-0682
Practice Address - Street 1:3951 FERRARA DR
Practice Address - Street 2:CONNECTICUT BELAIR MEDICAL PARK
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20906-4709
Practice Address - Country:US
Practice Address - Phone:301-942-0991
Practice Address - Fax:301-942-0682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-10
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0023050261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCP713-0001OtherBC/BS
MD787201100Medicaid
172177Medicare UPIN