| Prime Medicine Llc | |
|
12150 Annapolis Rd Suite 308 Glenn Dale MD 20769-9183 | |
| (301) 805-0006 | |
| (301) 805-5757 |
| Full Name | Prime Medicine Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 12150 Annapolis Rd, Glenn Dale, Maryland |
| Authorized Official Name and Position | Farhad Jamali (OWNER) |
| Authorized Official Contact | 3018050006 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Prime Medicine Llc Po Box 569 Greenbelt MD 20768-0569 Ph: (301) 805-0006 | Prime Medicine Llc 12150 Annapolis Rd Suite 308 Glenn Dale MD 20769-9183 Ph: (301) 805-0006 |
| NPI Number | 1134319395 |
|---|---|
| Provider Enumeration Date | 07/25/2007 |
| Last Update Date | 12/09/2011 |
| Medicare PECOS PAC ID | 2264508761 |
|---|---|
| Medicare Enrollment ID | O20080908000206 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134319395 | NPI | - | NPPES |
| 415340500 | Medicaid | MD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | D0058213 (Maryland) | Primary |
| Provider Name | Farhad Jamali |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1548248388 PECOS PAC ID: 8426962531 Enrollment ID: I20031113000489 |
| Provider Name | Parand Alavi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1801976139 PECOS PAC ID: 1557437852 Enrollment ID: I20080917000341 |
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