Provider Demographics
NPI:1760560031
Name:COMPLETE FAMILY CARE PC
Entity Type:Organization
Organization Name:COMPLETE FAMILY CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SURESH
Authorized Official - Middle Name:K
Authorized Official - Last Name:KHETAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-891-9770
Mailing Address - Street 1:PO BOX 7398
Mailing Address - Street 2:
Mailing Address - City:LANGLEY PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20787
Mailing Address - Country:US
Mailing Address - Phone:301-891-9770
Mailing Address - Fax:301-891-1620
Practice Address - Street 1:7610 CARROLL AVE
Practice Address - Street 2:# 260
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912
Practice Address - Country:US
Practice Address - Phone:301-891-9770
Practice Address - Fax:301-891-1620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD55403207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H14610Medicare UPIN
G00569Medicare ID - Type Unspecified