Basic Information
Provider Information
NPI: 1043537939
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: RAHMAN
FirstName: ASIMA
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2101 E JEFFERSON ST
Address2: SUITE 6W PPQA
City: ROCKVILLE
State: MD
PostalCode: 208524908
CountryCode: US
TelephoneNumber: 3018165853
FaxNumber:  
Practice Location
Address1: 1447 YORK RD
Address2: SUITE 100
City: LUTHERVILLE
State: MD
PostalCode: 210936017
CountryCode: US
TelephoneNumber: 4103395500
FaxNumber: 4103395695
Other Information
ProviderEnumerationDate: 04/30/2010
LastUpdateDate: 03/06/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XD0075313MDY Allopathic & Osteopathic PhysiciansInternal Medicine 

ID Information
IDTypeStateIssuerDescription
0685905MD MEDICAID


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