Healthcare Provider Details

I. General information

NPI: 1801993852
Provider Name (Legal Business Name): PAYMAUN M LOTFI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 10/04/2022
Certification Date: 10/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14605 POTOMAC BRANCH DR SUITE 300
WOODBRIDGE VA
22191-4070
US

IV. Provider business mailing address

PO BOX 5237
WOODBRIDGE VA
22194-5237
US

V. Phone/Fax

Practice location:
  • Phone: 703-490-1112
  • Fax: 703-878-8732
Mailing address:
  • Phone: 703-490-1112
  • Fax: 703-878-8732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number0101840469
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: