1134343304 NPI number — DR. MAHIN BANOU BEIRAGHDAR D.C.

Table of content: DR. MAHIN BANOU BEIRAGHDAR D.C. (NPI 1134343304)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134343304 NPI number — DR. MAHIN BANOU BEIRAGHDAR D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BEIRAGHDAR
Provider First Name:
MAHIN
Provider Middle Name:
BANOU
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BANOU
Provider Other First Name:
MAHIN
Provider Other Middle Name:
B.
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.C.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1134343304
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/05/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5824
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WASHINGTON
Provider Business Mailing Address State Name:
DC
Provider Business Mailing Address Postal Code:
20016-1424
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
202-265-6000
Provider Business Mailing Address Fax Number:
202-265-6018

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4123 CONNECTICUT AVE NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20008-1155
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-265-6000
Provider Business Practice Location Address Fax Number:
202-265-6018
Provider Enumeration Date:
04/12/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  CH19644 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 111N00000X , with the licence number: 924 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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