Healthcare Provider Details

I. General information

NPI: 1366447070
Provider Name (Legal Business Name): AMIR MIRZAALIKHANI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 10/12/2020
Certification Date: 10/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11711 LIVINGSTON RD
FORT WASHINGTON MD
20744-5151
US

IV. Provider business mailing address

8578 BRICKYARD RD
POTOMAC MD
20854-4833
US

V. Phone/Fax

Practice location:
  • Phone: 301-203-2232
  • Fax:
Mailing address:
  • Phone: 240-401-5699
  • Fax: 301-983-8110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD0046046
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberD0046046
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberD0046046
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: