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General NPI Number Information
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NPI Number | 1467448100
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Entity Type | Individual
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Provider Name | MASOOM M KANDAHARI MD FACP
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Gender | Male
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Dates
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Enumeration Date | 09/27/2005
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Last Update Date | 08/08/2023
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Provider Practice Location Address
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Address Line | 2280 OPITZ BLVD STE 340
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City | WOODBRIDGE
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State | VA
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Zip | 22191-3362
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Country | US
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Telephone | 703-590-8300
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Fax | 703-590-8301
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Provider Business Mailing Address
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Address Line | 1350 WOODSIDE DR
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City | MC LEAN
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State | VA
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Zip | 22102-1530
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Country | US
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Telephone |
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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 | 207RX0202X
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Taxonomy Name | Medical Oncology Physician
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License Number | 0101040044
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License Number State | VA
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