1760560031 NPI number — COMPLETE FAMILY CARE PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760560031 NPI number — COMPLETE FAMILY CARE PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMPLETE FAMILY CARE 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:
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:
1760560031
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7398
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LANGLEY PARK
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20787
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-891-9770
Provider Business Mailing Address Fax Number:
301-891-1620

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7610 CARROLL AVE
Provider Second Line Business Practice Location Address:
# 260
Provider Business Practice Location Address City Name:
TAKOMA PARK
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20912
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-891-9770
Provider Business Practice Location Address Fax Number:
301-891-1620
Provider Enumeration Date:
11/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KHETAN
Authorized Official First Name:
SURESH
Authorized Official Middle Name:
K
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
301-891-9770

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  D55403 , 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)





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