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General NPI Number Information
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NPI Number | 1952502304
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Entity Type | Organization
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Legal Business Name | MEHDI BAJOGHLI, M.D., P.C.
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Dates
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Enumeration Date | 05/31/2007
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Last Update Date | 09/02/2008
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Provider Practice Location Address
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Address Line | 2200 OPITZ BLVD SUITE 230
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City | WOODBRIDGE
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State | VA
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Zip | 22191-3321
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Country | US
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Telephone | 703-490-5803
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Fax |
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Provider Business Mailing Address
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Address Line | 2200 OPITZ BLVD SUITE 230
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City | WOODBRIDGE
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State | VA
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Zip | 22191-3321
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Country | US
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Telephone | 703-490-5803
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MEHDI BAJOGHLI
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Credential | M.D.
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Telephone | 703-490-5803
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 101036370
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License Number State | VA
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