1659396703 NPI number — FAMILY ENT ALLERGY AND ASTHMA CENTER PC

Table of content: KELLY BROWN JENKINS CPM, LM (NPI 1649619313)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659396703 NPI number — FAMILY ENT ALLERGY AND ASTHMA CENTER PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY ENT ALLERGY AND ASTHMA CENTER PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659396703
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/14/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
806 W DIAMOND AVE
Provider Second Line Business Mailing Address:
SUITE 360
Provider Business Mailing Address City Name:
GAITHERSBURG
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20878-1415
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-948-4066
Provider Business Mailing Address Fax Number:
301-963-2283

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
806 W DIAMOND AVE
Provider Second Line Business Practice Location Address:
SUITE 360
Provider Business Practice Location Address City Name:
GAITHERSBURG
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20878-1415
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-948-4066
Provider Business Practice Location Address Fax Number:
301-963-2283
Provider Enumeration Date:
07/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SEKHSARIA
Authorized Official First Name:
VIBHAV
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER, MD
Authorized Official Telephone Number:
301-468-5922

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  D0044244 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com