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General NPI Number Information
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NPI Number | 1225724610
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Entity Type | Organization
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Legal Business Name | ALLEVIUS CLINIC
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Dates
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Enumeration Date | 04/18/2023
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Last Update Date | 05/24/2024
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Provider Practice Location Address
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Address Line | 1570 ONYX DR UNIT 305
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City | MC LEAN
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State | VA
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Zip | 22102-3957
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Country | US
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Telephone | 276-500-0338
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Fax |
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Provider Business Mailing Address
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Address Line | 1570 ONYX DR UNIT 305
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City | MC LEAN
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State | VA
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Zip | 22102-3957
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Country | US
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Telephone | 276-500-0338
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | MEHRAN BAJOGHLI
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Credential | MD
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Telephone | 276-500-0338
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207U00000X
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Taxonomy Name | Nuclear Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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