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NPI Code Detail

MEDICARE: LYANA MAHMOUDI MD

MEDICARE: LYANA MAHMOUDI 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
1207Q00000XFamily Medicine Physician0101278308VA

General Provider Information

NPI Number : 1548750292
Entity Type Code : Individual
Provider Name (Legal Business Name) : LYANA MAHMOUDI MD
Provider Business Mailing Address
First Line : 12101 CAROL LN
Second Line :
City : FREDERICKSBURG
State : VA
Zip : 22407-6103
Country : US
Telephone Number : 540-741-9300
Fax Number :
Provider Business Practice Location Address
First Line : 12101 CAROL LN STE 101
Second Line :
City : FREDERICKSBURG
State : VA
Zip : 22407-6104
Country : US
Telephone Number : 540-741-9300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/17/2018
Last Update Date : 02/19/2025

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