=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811925928
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MERDOD GHAFOURI DO
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/29/2006
-----------------------------------------------------
Last Update Date | 09/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7617 LITTLE RIVER TURN PIKE SUITE 710
-----------------------------------------------------
City | ANNANDALE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22003-2635
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-335-5750
-----------------------------------------------------
Fax | 571-358-3941
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8100 ASHTON AVE STE 200
-----------------------------------------------------
City | MANASSAS
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20109-5688
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-335-8750
-----------------------------------------------------
Fax | 571-358-3941
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | 0102201022
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------