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General NPI Number Information
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NPI Number | 1396049722
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Entity Type | Organization
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Legal Business Name | REZA GHORBANI MD PC
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Dates
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Enumeration Date | 12/28/2010
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Last Update Date | 12/28/2010
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Provider Practice Location Address
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Address Line | 5530 WISCONSIN AVE 1550
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City | BETHESDA
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State | MD
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Zip | 20815-4404
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Country | US
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Telephone | 301-220-1333
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Fax | 301-215-4157
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Provider Business Mailing Address
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Address Line | PO BOX 71155
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City | BETHESDA
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State | MD
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Zip | 20813-1155
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Country | US
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Telephone | 301-220-1333
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/MEDICAL DIRECTOR
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Name | REZA GHORBANI
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Credential | M.D.
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Telephone | 781-727-1352
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | D0065935
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | D0065935
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License Number State | MD
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