1073748547 NPI number — AMIR AHMADIYAR DC PC II

Table of content: (NPI 1073748547)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073748547 NPI number — AMIR AHMADIYAR DC PC II

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMIR AHMADIYAR DC PC II
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073748547
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/28/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6521 ARLINGTON BLVD
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
FALLS CHURCH
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22042-3016
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-538-5455
Provider Business Mailing Address Fax Number:
703-538-6675

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
44121 HARRY BYRD HWY
Provider Second Line Business Practice Location Address:
145
Provider Business Practice Location Address City Name:
ASHBURN
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20147-5667
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-858-9988
Provider Business Practice Location Address Fax Number:
703-858-9932
Provider Enumeration Date:
05/27/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
FERNANDEZ
Authorized Official First Name:
DULCE
Authorized Official Middle Name:
E
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
703-858-9988

Provider Taxonomy Codes

  • Taxonomy code: 111NR0400X , with the licence number:  0104001051 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)