Healthcare Provider Details

I. General information

NPI: 1437237468
Provider Name (Legal Business Name): ALI REZAZADEH TEHRANI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 09/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9801 GEORGIA AVE SUITE 3-41
SILVER SPRING MD
20902-5276
US

IV. Provider business mailing address

9801 GEORGIA AVE SUITE 3-41
SILVER SPRING MD
20902-5276
US

V. Phone/Fax

Practice location:
  • Phone: 301-681-1535
  • Fax: 300-168-1394
Mailing address:
  • Phone: 301-681-1535
  • Fax: 301-681-3949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberD0046939
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: