1306881941 NPI number — ROYA AZARMAHAN, M.D.

Table of content: (NPI 1306881941)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306881941 NPI number — ROYA AZARMAHAN, M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROYA AZARMAHAN, M.D.
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:
1306881941
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1715 N GEORGE MASON DR
Provider Second Line Business Mailing Address:
SUITE 501
Provider Business Mailing Address City Name:
ARLINGTON
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22205-3609
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-812-3820
Provider Business Mailing Address Fax Number:
703-812-3822

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1715 N GEORGE MASON DR
Provider Second Line Business Practice Location Address:
SUITE 501
Provider Business Practice Location Address City Name:
ARLINGTON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22205-3609
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-812-3820
Provider Business Practice Location Address Fax Number:
703-812-3822
Provider Enumeration Date:
06/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
AZAR-MAHAN
Authorized Official First Name:
ROYA
Authorized Official Middle Name:
Authorized Official Title or Position:
DOCTOR
Authorized Official Telephone Number:
703-812-3820

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  0101050996 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 334316 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 5820545 . This is a "MEDICAID" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 5880166 . This is a "AETNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 0400896 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 334316 . This is a "CAREFIRST B/C B/S" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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