Provider Demographics
NPI:1831705748
Name:PREMIER HEALTH EXPRESS AND ADVANCED DIAGNOSTICS INC
Entity type:Organization
Organization Name:PREMIER HEALTH EXPRESS AND ADVANCED DIAGNOSTICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:NOKURI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:443-899-9525
Mailing Address - Street 1:9710 PATUXENT WOODS DR STE 200
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-3458
Mailing Address - Country:US
Mailing Address - Phone:443-899-9525
Mailing Address - Fax:
Practice Address - Street 1:5474 SAINT BARNABAS RD
Practice Address - Street 2:
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-3622
Practice Address - Country:US
Practice Address - Phone:443-899-9525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PREMIER HEALTH EXPRESS AND ADVANCED DIAGNOSTICS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-09-17
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty