MEDICARE: AFSANE HADDAD-MASHAD MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	0101052422	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053349498
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AFSANE HADDAD-MASHAD MD

Provider Business Mailing Address
First Line	:	PO BOX 20955
Second Line	:
City	:	BELFAST
State	:	ME
Zip	:	04915-4106
Country	:	US
Telephone Number	:	703-827-8688
Fax Number	:	703-827-8344

Provider Business Practice Location Address
First Line	:	8230 BOONE BLVD STE 203
Second Line	:
City	:	VIENNA
State	:	VA
Zip	:	22182-2647
Country	:	US
Telephone Number	:	703-827-8688
Fax Number	:	703-827-8344

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2006
Last Update Date	:	05/29/2025

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