Provider Demographics
NPI:1174112734
Name:ELITE PRIMARY CARE GROUP LLC
Entity type:Organization
Organization Name:ELITE PRIMARY CARE GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-ONWER
Authorized Official - Prefix:
Authorized Official - First Name:FAHIMA
Authorized Official - Middle Name:
Authorized Official - Last Name:AZIZI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-796-8367
Mailing Address - Street 1:801 TOLL HOUSE AVE STE D3
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-6112
Mailing Address - Country:US
Mailing Address - Phone:405-796-8367
Mailing Address - Fax:405-716-4808
Practice Address - Street 1:801 TOLL HOUSE AVE STE D3
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-6112
Practice Address - Country:US
Practice Address - Phone:405-796-8367
Practice Address - Fax:405-716-4808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-18
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty