Provider Demographics
NPI:1619710761
Name:KHOSROW DAVACHI MD PC
Entity type:Organization
Organization Name:KHOSROW DAVACHI MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KHOSROW
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVACHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-868-7121
Mailing Address - Street 1:7700 OLD BRANCH AVE STE D203
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-1611
Mailing Address - Country:US
Mailing Address - Phone:301-868-7121
Mailing Address - Fax:301-868-7968
Practice Address - Street 1:7700 OLD BRANCH AVE STE D203
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-1611
Practice Address - Country:US
Practice Address - Phone:301-868-7121
Practice Address - Fax:301-868-7968
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KHOSROW DAVACHI MD PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty