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General NPI Number Information
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NPI Number | 1932110269
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Entity Type | Organization
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Legal Business Name | G. REZA MEHRYAR, M.D., NEUROLOGY, P.C.
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Dates
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Enumeration Date | 08/11/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3650 JOSEPH SIEWICK DR #310
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City | FAIRFAX
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State | VA
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Zip | 22033-1710
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Country | US
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Telephone | 703-620-2929
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Fax | 703-620-1711
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Provider Business Mailing Address
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Address Line | 3650 JOSEPH SIEWICK DR #310
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City | FAIRFAX
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State | VA
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Zip | 22033-1710
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Country | US
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Telephone | 703-620-2929
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Fax | 703-620-1711
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Authorized Official
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Title or Position | OWNER
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Name | GHOLAM REZA MEHRYAR
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Credential | M.D.
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Telephone | 703-620-2929
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 22328
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License Number State | VA
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