Healthcare Provider Details

I. General information

NPI: 1730593377
Provider Name (Legal Business Name): BANAFSHEH LOTFI MOGHADDAS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2014
Last Update Date: 09/29/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7440 SPRING VILLAGE DR
SPRINGFIELD VA
22150-4446
US

IV. Provider business mailing address

5730 EXECUTIVE DR STE 230
CATONSVILLE MD
21228-1762
US

V. Phone/Fax

Practice location:
  • Phone: 703-923-4644
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD461587
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: