| Doctor Name: | DR. NADER TAVAKOLI-JALILI |
| NPI Number: | 1407059413 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | D0041978 |
| Business Practice Address: | 12200 Annapolis Rd #228 Glenn Dale, MD - 207699182 |
| Business Phone Number: | 3013527118 |
| Business Fax Number: | |
| Mailing Address: | 626c Admiral Dr, # 235 ANNAPOLIS |
| State: | MD |
| Postal Code: | 214012151 |
| Phone Number: | 3013527118 |
| Fax Number: | |
| NPI Enumeration Date: | 06/07/2007 |
| NPI Last Update Date: | 02/14/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207QA0505X |
| License Number: | D0041978 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MD |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Family Medicine |
| Taxonomy Specialization: | Adult Medicine |
| Taxonomy Definition: | |