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General NPI Number Information
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NPI Number | 1992964621
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Entity Type | Individual
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Provider Name | MASOUD REZVANI M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/06/2008
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 14904 JEFFERSON DAVIS HWY STE 209
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City | WOODBRIDGE
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State | VA
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Zip | 22191-3908
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Country | US
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Telephone | 703-595-4566
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Fax | 703-350-4891
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Provider Business Mailing Address
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Address Line | 1077 PENSIVE LN
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City | GREAT FALLS
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State | VA
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Zip | 22066-1712
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Country | US
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Telephone | 267-317-6364
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Fax | 888-588-0634
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | MD433181
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License Number State | PA
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