MEDICARE: MRS. ROKSANA GHASEMZADEH M.D

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	174400000X	Specialist	0101233103	VA

General Provider Information

NPI Number	:	1033128798
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ROKSANA GHASEMZADEH M.D

Provider Business Mailing Address
First Line	:	1581 SPRING GATE DR UNIT 5412
Second Line	:
City	:	MCLEAN
State	:	VA
Zip	:	22102-3442
Country	:	US
Telephone Number	:	703-855-4167
Fax Number	:

Provider Business Practice Location Address
First Line	:	14573 POTOMAC MILLS RD
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22192-6808
Country	:	US
Telephone Number	:	703-497-1234
Fax Number	:

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

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	07/08/2007

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