Healthcare Provider Details

I. General information

NPI: 1841280369
Provider Name (Legal Business Name): BABAK RAISSI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 11/25/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8700 SUDLEY RD
MANASSAS VA
20110-4418
US

IV. Provider business mailing address

3400 WAKE FOREST RD
RALEIGH NC
27609-7317
US

V. Phone/Fax

Practice location:
  • Phone: 703-369-8073
  • Fax:
Mailing address:
  • Phone: 919-954-3624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number2025-02991
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberD0102348
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number0101283742
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberD0102348
License Number StateMD
# 5
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD11122
License Number StateRI
# 6
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number0101283742
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: