Healthcare Provider Details

I. General information

NPI: 1659310043
Provider Name (Legal Business Name): NAGHMEH TEBYANIAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 03/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6136 BRANDON AVE
SPRINGFIELD VA
22150-2610
US

IV. Provider business mailing address

6136 BRANDON AVE
SPRINGFIELD VA
22150-2610
US

V. Phone/Fax

Practice location:
  • Phone: 703-866-3131
  • Fax: 703-866-3133
Mailing address:
  • Phone: 703-866-3131
  • Fax: 703-866-3133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number0101054906
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: