MEDICARE: BENJAMIN BEHNOUD NIA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	0101275514	VA
2	207R00000X	Internal Medicine Physician	BP10063399	TX
3	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1003312729
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENJAMIN BEHNOUD NIA MD

Provider Business Mailing Address
First Line	:	1221 MASSACHUSETTS AVE NW APT 1017
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20005-5331
Country	:	US
Telephone Number	:	328-636-3958
Fax Number	:

Provider Business Practice Location Address
First Line	:	3700 JOSEPH SIEWICK DR STE 302
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22033-1739
Country	:	US
Telephone Number	:	703-648-2488
Fax Number	:	703-648-2489

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/02/2018
Last Update Date	:	08/03/2022

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