Healthcare Provider Details

I. General information

NPI: 1831772409
Provider Name (Legal Business Name): AZADEH PAJOOHESH GOLDBERG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2021
Last Update Date: 04/25/2025
Certification Date: 04/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 BEVERLY RD STE 3001420
MC LEAN VA
22101-3732
US

IV. Provider business mailing address

1420 BEVERLY RD STE 3001420
MC LEAN VA
22101-3732
US

V. Phone/Fax

Practice location:
  • Phone: 703-852-8588
  • Fax: 410-354-7942
Mailing address:
  • Phone: 703-852-8588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0024181276
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024181276
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: