Healthcare Provider Details

I. General information

NPI: 1881669919
Provider Name (Legal Business Name): MARYAM ZAMANI, M.D., PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3229 WOODBURN RD STE 350
ANNANDALE VA
22003-1274
US

IV. Provider business mailing address

3229 WOODBURN RD STE 350
ANNANDALE VA
22003-1274
US

V. Phone/Fax

Practice location:
  • Phone: 410-848-8202
  • Fax: 410-848-2644
Mailing address:
  • Phone: 410-848-8202
  • Fax: 410-848-2644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number0101237180
License Number StateVA

VIII. Authorized Official

Name: MARYAM ZAMANI
Title or Position: MEDICAL DIRECTOR
Credential: M.D., PC
Phone: 410-848-8202