=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912603291
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COSMOPOLITAN PAIN AND SPINE CENTER LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/07/2023
-----------------------------------------------------
Last Update Date | 07/29/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4200 EVERGREEN LN STE 322
-----------------------------------------------------
City | ANNANDALE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22003-3252
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 571-347-7800
-----------------------------------------------------
Fax | 571-347-7800
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4200 EVERGREEN LN STE 322
-----------------------------------------------------
City | ANNANDALE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22003-3252
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 571-777-5800
-----------------------------------------------------
Fax | 571-347-7800
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR
-----------------------------------------------------
Name | BABAK BEDAYAT
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 408-306-6852
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208VP0014X
-----------------------------------------------------
Taxonomy Name | Interventional Pain Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------