Healthcare Provider Details

I. General information

NPI: 1497818439
Provider Name (Legal Business Name): ABDOLREZA GHAZINOURI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6121 MONTROSE RD
ROCKVILLE MD
20852-4803
US

IV. Provider business mailing address

7006 DELAWARE ST
CHEVY CHASE MD
20815-4162
US

V. Phone/Fax

Practice location:
  • Phone: 301-770-8377
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD0060170
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: