Healthcare Provider Details

I. General information

NPI: 1659423648
Provider Name (Legal Business Name): DOCTOR AMIR MIRZAALIKHANI, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 12/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 CENTENNIAL ST STE B
LA PLATA MD
20646-5976
US

IV. Provider business mailing address

8578 BRICKYARD RD
POTOMAC MD
20854-4833
US

V. Phone/Fax

Practice location:
  • Phone: 301-934-6060
  • Fax: 301-934-4523
Mailing address:
  • Phone: 301-983-6656
  • Fax: 301-983-8110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberD0046046
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberD0026262
License Number StateMD

VIII. Authorized Official

Name: DR. AMIR M ALIKHANI
Title or Position: PRESIDENT
Credential: MD
Phone: 301-983-6656