MEDICARE: NADERI CENTER FOR COSMETIC SURGERY & SKIN CARE, PLLC

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	207YX0905X	Otolaryngology/Facial Plastic Surgery Physician

General Provider Information

NPI Number	:	1831337898
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NADERI CENTER FOR COSMETIC SURGERY & SKIN CARE, PLLC

Provider Business Mailing Address
First Line	:	1850 TOWN CENTER PARKWAY
Second Line	:	SUITE 551
City	:	RESTON
State	:	VA
Zip	:	20190-3300
Country	:	US
Telephone Number	:	703-481-0002
Fax Number	:	703-481-5002

Provider Business Practice Location Address
First Line	:	1850 TOWN CENTER PARKWAY
Second Line	:	SUITE 551
City	:	RESTON
State	:	VA
Zip	:	20190-3300
Country	:	US
Telephone Number	:	703-481-0002
Fax Number	:	703-481-5002

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SHERVIN NADERI
Credential	:	MD
Telephone Number	:	703-481-0002

Provider Enumeration Date	:	01/29/2009
Last Update Date	:	02/28/2022

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