Healthcare Provider Details

I. General information

NPI: 1982667580
Provider Name (Legal Business Name): SHAHZAD RAHMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: SHAHZAD RAHMAN

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 10/02/2020
Certification Date: 09/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

THE RENASCENCE CENTER 46 S GLEBE ROAD, SUITE 103
ARLINGTON VA
22204
US

IV. Provider business mailing address

8340 GREENSBORO DR UNIT 120
MC LEAN VA
22102-3535
US

V. Phone/Fax

Practice location:
  • Phone: 703-521-6004
  • Fax: 703-521-6342
Mailing address:
  • Phone: 703-200-1721
  • Fax: 703-521-6342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101051872
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: