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General NPI Number Information
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NPI Number | 1699868786
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Entity Type | Individual
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Provider Name | MEHRAN BAJOGHLI M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/02/2006
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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 | 703-244-9117
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Fax | 571-200-2618
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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 | 703-244-9117
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Fax | 571-200-2618
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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 | 207U00000X
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Taxonomy Name | Nuclear Medicine Physician
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License Number | 07395
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207RA0401X
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Taxonomy Name | Addiction Medicine (Internal Medicine) Physician
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License Number | 0101231597
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 0101231597
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License Number State | VA
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