Provider Demographics
NPI:1598774127
Name:ADELE M ASIMOW PHD PA
Entity Type:Organization
Organization Name:ADELE M ASIMOW PHD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF CORPORATION
Authorized Official - Prefix:DR
Authorized Official - First Name:ADELE
Authorized Official - Middle Name:MAN KUEN
Authorized Official - Last Name:ASIMOW
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:301-977-5477
Mailing Address - Street 1:19517 GALLATIN CT
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY VILLAGE
Mailing Address - State:MD
Mailing Address - Zip Code:20886
Mailing Address - Country:US
Mailing Address - Phone:301-977-5477
Mailing Address - Fax:301-990-7289
Practice Address - Street 1:19517 GALLATIN CT
Practice Address - Street 2:
Practice Address - City:MONTGOMERY VILLAGE
Practice Address - State:MD
Practice Address - Zip Code:20886
Practice Address - Country:US
Practice Address - Phone:301-977-5477
Practice Address - Fax:301-990-7289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD569103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD408824Medicare PIN