Provider Demographics
NPI:1770810038
Name:ADVANCED GI ASSOCIATES LLC
Entity type:Organization
Organization Name:ADVANCED GI ASSOCIATES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:DR
Authorized Official - First Name:HOMAYOON
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHJOOB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-770-5711
Mailing Address - Street 1:10846 ANTIGUA TER
Mailing Address - Street 2:#203
Mailing Address - City:NORTH BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20852-5532
Mailing Address - Country:US
Mailing Address - Phone:301-770-5711
Mailing Address - Fax:
Practice Address - Street 1:10846 ANTIGUA TER
Practice Address - Street 2:#203
Practice Address - City:NORTH BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20852-5532
Practice Address - Country:US
Practice Address - Phone:301-770-5711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-06
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0058186207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty