Healthcare Provider Details

I. General information

NPI: 1932484961
Provider Name (Legal Business Name): BAHMAN SHAHIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2011
Last Update Date: 10/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8294 OLD COURTHOUSE RD
VIENNA VA
22182-3871
US

IV. Provider business mailing address

8294 OLD COURTHOUSE RD STE A
VIENNA VA
22182-3871
US

V. Phone/Fax

Practice location:
  • Phone: 703-356-7882
  • Fax: 703-356-4850
Mailing address:
  • Phone: 703-356-7882
  • Fax: 703-356-4850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101024447
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: