MEDICARE: DR. POURAN NADJI NOWROOZI 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	207V00000X	Obstetrics & Gynecology Physician	0101034539	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	258983	OTHER	VA	ANTHEM
2	PAR	OTHER	VA	USA MANAGED CARE
3	PAR	OTHER	VA	FIRST HEALTH COMMERCIAL/SOUTHERN HEALT/COVENTRY
4	PAR	OTHER	VA	VIRGINIA PREMIER HEALTH
5	PAR	OTHER	VA	VIRGINIA HEALTH NETWORK
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	PAR	OTHER	VA	TRICARE/CHAMPUS
9	PAR	OTHER	VA	MULTIPLAN
10	14361	OTHER	VA	SENTARA OPTIMA
11	PAR	OTHER	VA	CIGNA
12	10003529	OTHER	VA	SENTARA OPTIMA
13	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
14	2146283	OTHER	VA	UHC/MAMSI
15	PAR	OTHER	VA	AETNA
16	PAR	OTHER	VA	CORVEL/CORCARE
17	064NF	OTHER	NC	BC/BS

General Provider Information

NPI Number	:	1184690661
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. POURAN NADJI NOWROOZI MD

Provider Business Mailing Address
First Line	:	PO BOX 936
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23501-0936
Country	:	US
Telephone Number	:	757-625-0557
Fax Number	:	757-625-1361

Provider Business Practice Location Address
First Line	:	160 KINGSLEY LN
Second Line	:	SUITE 205 DEPAUL ATRIUM
City	:	NORFOLK
State	:	VA
Zip	:	23505-4600
Country	:	US
Telephone Number	:	757-625-0557
Fax Number	:	757-625-1361

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

Provider Enumeration Date	:	02/24/2006
Last Update Date	:	01/27/2009

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