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General NPI Number Information
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NPI Number | 1063734820
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Entity Type | Organization
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Legal Business Name | MORTEZA S. MOUSAVI, M.D., P.C.
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Dates
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Enumeration Date | 02/22/2010
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Last Update Date | 04/01/2010
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Provider Practice Location Address
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Address Line | 2296 OPITZ BLVD SUITE 340
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City | WOODBRIDGE
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State | VA
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Zip | 22191-3300
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Country | US
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Telephone | 703-878-0941
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Fax | 703-878-0857
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Provider Business Mailing Address
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Address Line | 2296 OPITZ BLVD. SUITE 340
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City | WOODBRIDGE
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State | VA
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Zip | 22191-3346
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Country | US
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Telephone | 703-878-0941
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Fax | 703-878-0857
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Authorized Official
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Title or Position | OWNER
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Name | DR. MORTEZA S. MOUSAVI
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Credential | M.D.
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Telephone | 703-878-0941
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 0101033951
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License Number State | VA
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