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General NPI Number Information
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NPI Number | 1366644254
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Entity Type | Individual
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Provider Name | SOROUR AMIRHAERI PHD, PA-C
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Gender | Female
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Dates
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Enumeration Date | 06/03/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2041 GEORGIA AVE NW
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City | WASHINGTON
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State | DC
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Zip | 20060-0001
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Country | US
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Telephone | 202-865-1141
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Fax |
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Provider Business Mailing Address
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Address Line | 6203 ADELAIDE DR
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City | BETHESDA
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State | MD
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Zip | 20817-2425
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Country | US
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Telephone | 301-530-0712
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Fax |
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA030312
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License Number State | DC
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