Healthcare Provider Details

I. General information

NPI: 1154424232
Provider Name (Legal Business Name): KAVOOS NOORI MESBAHI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10169 PALMER DR
OAKTON VA
22124-2623
US

IV. Provider business mailing address

PO BOX 3036
OAKTON VA
22124-9036
US

V. Phone/Fax

Practice location:
  • Phone: 703-898-5303
  • Fax:
Mailing address:
  • Phone: 703-257-2070
  • Fax: 703-257-2072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0101037826
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number0101037826
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101037826
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0101037826
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: