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General NPI Number Information
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NPI Number | 1699886861
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Entity Type | Organization
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Legal Business Name | HAMID R POURSHOJAE DO PC
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2280 OPITZ BLVD SUITE 320
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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 | 703-878-7610
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Fax | 703-878-7614
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Provider Business Mailing Address
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Address Line | 2280 OPITZ BLVD SUITE 320
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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 | 703-878-7610
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Fax | 703-878-7614
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Authorized Official
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Title or Position | OWNER PHYSICIAN
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Name | HAMID R POURSHOJAE
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Credential | DO
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Telephone | 703-878-7610
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 0102201710
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License Number State | VA
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