Provider Demographics
NPI:1841489804
Name:PANTEA TAMJIDI MD PC
Entity type:Organization
Organization Name:PANTEA TAMJIDI MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PANTEA
Authorized Official - Middle Name:
Authorized Official - Last Name:TAMJIDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-652-4828
Mailing Address - Street 1:5454 WISCONSIN AVE
Mailing Address - Street 2:SUITE 1045
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-6917
Mailing Address - Country:US
Mailing Address - Phone:301-652-4828
Mailing Address - Fax:301-652-2070
Practice Address - Street 1:5454 WISCONSIN AVE
Practice Address - Street 2:SUITE 1045
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-6917
Practice Address - Country:US
Practice Address - Phone:301-652-4828
Practice Address - Fax:301-652-2070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0063624207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCG02266Medicare PIN
DCDF2571Medicare PIN