Provider Demographics
NPI:1336927656
Name:MY MED CLINIC PA
Entity Type:Organization
Organization Name:MY MED CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FARZANA
Authorized Official - Middle Name:
Authorized Official - Last Name:AJMAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-540-1332
Mailing Address - Street 1:13225 EXECUTIVE PARK TER
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-2648
Mailing Address - Country:US
Mailing Address - Phone:202-584-9346
Mailing Address - Fax:
Practice Address - Street 1:13225 EXECUTIVE PARK TER
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-2648
Practice Address - Country:US
Practice Address - Phone:301-852-1374
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-18
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty