Healthcare Provider Details

I. General information

NPI: 1437271889
Provider Name (Legal Business Name): ATOOSA KASHANI DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2007
Last Update Date: 08/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7540-I LITTLE RIVER TURNPIKE
ANNANDALE VA
22003-5152
US

IV. Provider business mailing address

14803 HARTLAUB CT
CENTREVILLE VA
20120-2962
US

V. Phone/Fax

Practice location:
  • Phone: 703-750-1124
  • Fax:
Mailing address:
  • Phone: 703-401-6323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number0103300978
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: