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General NPI Number Information
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NPI Number | 1992774533
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Entity Type | Individual
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Provider Name | MITRA FOROOGH-NASSIRAEE M.D.
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Gender | Female
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Dates
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Enumeration Date | 03/16/2006
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Last Update Date | 04/24/2019
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Provider Practice Location Address
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Address Line | 7620 CARROLL AVE STE 201
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City | TAKOMA PARK
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State | MD
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Zip | 20912-6388
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Country | US
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Telephone | 18-916-6473
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Fax | 301-891-6654
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Provider Business Mailing Address
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Address Line | 26005 RIDGE RD STE 200
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City | DAMASCUS
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State | MD
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Zip | 20872-1899
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Country | US
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Telephone | 301-414-2300
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Fax | 301-414-0476
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | D0060745
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License Number State | MD
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