Healthcare Provider Details

I. General information

NPI: 1992152748
Provider Name (Legal Business Name): ZOHREH ABYANEH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2016
Last Update Date: 07/06/2020
Certification Date: 07/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2026 OPITZ BLVD STE A
WOODBRIDGE VA
22191-3332
US

IV. Provider business mailing address

2026 OPITZ BLVD STE A
WOODBRIDGE VA
22191-3332
US

V. Phone/Fax

Practice location:
  • Phone: 571-992-8005
  • Fax: 703-494-3958
Mailing address:
  • Phone: 571-992-8005
  • Fax: 703-494-3958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: ZOHREH NIKKHAH ABYANEH
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 571-992-8005