Healthcare Provider Details

I. General information

NPI: 1164676409
Provider Name (Legal Business Name): NASRIN EJTEMAEE MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2008
Last Update Date: 11/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8375A GREENSBORO DR
MC LEAN VA
22102-3529
US

IV. Provider business mailing address

8375A GREENSBORO DR
MC LEAN VA
22102-3529
US

V. Phone/Fax

Practice location:
  • Phone: 703-893-8345
  • Fax: 703-356-2730
Mailing address:
  • Phone: 703-893-8345
  • Fax: 703-356-2730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. NASRIN EJTEMAEE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 703-893-8345