MEDICARE: DR. AMIR HOUSHANG MOAZZEZ M.D.

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	208600000X	Surgery Physician	0101235385	VA

General Provider Information

NPI Number	:	1619963139
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMIR HOUSHANG MOAZZEZ M.D.

Provider Business Mailing Address
First Line	:	3580 JOSEPH SIEWICK DR STE 205
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22033-1764
Country	:	US
Telephone Number	:	703-620-3211
Fax Number	:	703-620-3215

Provider Business Practice Location Address
First Line	:	3580 JOSEPH SIEWICK DR STE 205
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22033-1764
Country	:	US
Telephone Number	:	703-620-3211
Fax Number	:	703-620-3215

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

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	11/13/2025

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