Healthcare Provider Details

I. General information

NPI: 1487755120
Provider Name (Legal Business Name): FATEMEH NEMATZADEH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 04/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8550 ARLINGTON BLVD SUITE # 310
FAIRFAX VA
22031-4634
US

IV. Provider business mailing address

46179 WESTLAKE DR STE 250
STERLING VA
20165-5882
US

V. Phone/Fax

Practice location:
  • Phone: 571-375-2286
  • Fax: 571-375-2287
Mailing address:
  • Phone: 571-375-2286
  • Fax: 571-375-2287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101238065
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number0101238065
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: