Healthcare Provider Details

I. General information

NPI: 1053377903
Provider Name (Legal Business Name): ROBERT S BAHADORI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 12/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8316 ARLINGTON BLVD SUITE 300
FAIRFAX VA
22031-5207
US

IV. Provider business mailing address

3801 UNIVERSITY DR
FAIRFAX VA
22030-2503
US

V. Phone/Fax

Practice location:
  • Phone: 703-573-7600
  • Fax: 703-560-3808
Mailing address:
  • Phone: 703-383-8130
  • Fax: 703-383-7353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number0101053696
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License Number0101053696
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: