Provider Demographics
NPI:1912160458
Name:DOCTORS FIRST PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:DOCTORS FIRST PROFESSIONAL CORPORATION
Other - Org Name:DOCTORS FIRST PROFESSIONAL CORPORATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAKELYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:CALLEJAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-454-4682
Mailing Address - Street 1:12800 MIDDLEBROOK RD STE 400
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-5282
Mailing Address - Country:US
Mailing Address - Phone:240-701-3013
Mailing Address - Fax:
Practice Address - Street 1:12800 MIDDLEBROOK RD STE 400
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-5282
Practice Address - Country:US
Practice Address - Phone:240-215-3301
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-04
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0063383261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDI41401Medicare UPIN