Healthcare Provider Details

I. General information

NPI: 1295773679
Provider Name (Legal Business Name): HAMID TAHERI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 09/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8100 ASHTON AVE SUITE 200
MANASSAS VA
20109-5622
US

IV. Provider business mailing address

8100 ASHTON AVE SUITE 200
MANASSAS VA
20109-5622
US

V. Phone/Fax

Practice location:
  • Phone: 703-335-8750
  • Fax: 703-331-0254
Mailing address:
  • Phone: 703-331-0300
  • Fax: 703-331-0254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number101052820
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: