Healthcare Provider Details

I. General information

NPI: 1497850077
Provider Name (Legal Business Name): NASRIN EJTEMAEE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 09/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8375 GREENSBORO DR # A
MCLEAN VA
22102-3529
US

IV. Provider business mailing address

8375 GREENSBORO DR # A
MCLEAN 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 Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101221367
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: