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General NPI Number Information
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NPI Number | 1629073994
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Entity Type | Individual
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Provider Name | BEHNAM M GOUDARZI M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/14/2005
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Last Update Date | 08/16/2013
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Provider Practice Location Address
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Address Line | 2028 OPITZ BLVD STE B
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City | WOODBRIDGE
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State | VA
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Zip | 22191-3326
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Country | US
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Telephone | 703-497-0212
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Fax | 703-497-0421
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Provider Business Mailing Address
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Address Line | 2028 OPITZ BLVD STE B
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City | WOODBRIDGE
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State | VA
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Zip | 22191-3326
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Country | US
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Telephone | 703-497-0212
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Fax | 703-497-0421
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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 | 207RS0012X
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Taxonomy Name | Sleep Medicine (Internal Medicine) Physician
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License Number | 0101239238
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | 0101238239
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 0101239238
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License Number State | VA
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