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General NPI Number Information
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NPI Number | 1225077613
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Entity Type | Individual
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Provider Name | AZITA MOALEMI MD
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Gender | Female
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Dates
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Enumeration Date | 06/04/2006
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Last Update Date | 02/20/2008
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Provider Practice Location Address
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Address Line | 6136 BRANDON AVE
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City | SPRINGFIELD
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State | VA
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Zip | 22150-2610
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Country | US
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Telephone | 703-866-3131
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Fax | 703-866-3133
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Provider Business Mailing Address
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Address Line | 6136 BRANDON AVE
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City | SPRINGFIELD
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State | VA
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Zip | 22150-2610
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Country | US
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Telephone | 703-866-3131
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Fax | 703-866-3133
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 0101049935
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License Number State | VA
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