Provider Demographics
NPI:1245327881
Name:PRIMECARE MEDICINE PA
Entity type:Organization
Organization Name:PRIMECARE MEDICINE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANURADHA
Authorized Official - Middle Name:A
Authorized Official - Last Name:ARUN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-593-9800
Mailing Address - Street 1:PO BOX 1708
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20915-1708
Mailing Address - Country:US
Mailing Address - Phone:301-593-9800
Mailing Address - Fax:301-593-1061
Practice Address - Street 1:9801 GEORGIA AVE
Practice Address - Street 2:SUITE 224
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-5276
Practice Address - Country:US
Practice Address - Phone:301-593-9800
Practice Address - Fax:301-593-1061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0057630207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD699207200Medicaid
DCG01555Medicare PIN
MD699207200Medicaid
DCH52824Medicare UPIN