Healthcare Provider Details

I. General information

NPI: 1679748669
Provider Name (Legal Business Name): BENJAMIN VAGHARI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2008
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 WISCONSIN AVE
BETHESDA MD
20889-0004
US

IV. Provider business mailing address

7804 ELMWOOD RD
FULTON MD
20759-2636
US

V. Phone/Fax

Practice location:
  • Phone: 301-295-4600
  • Fax:
Mailing address:
  • Phone: 610-804-7197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD442529
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number229530
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: