Healthcare Provider Details

I. General information

NPI: 1730162967
Provider Name (Legal Business Name): MEHRDAD EBADI-TEHRANI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 03/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5226 DAWES AVE
ALEXANDRIA VA
22311-1404
US

IV. Provider business mailing address

5226 DAWES AVE
ALEXANDRIA VA
22311-1404
US

V. Phone/Fax

Practice location:
  • Phone: 703-379-9111
  • Fax: 703-931-7952
Mailing address:
  • Phone: 703-379-9111
  • Fax: 703-931-7952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number0101053922
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: