1992788806 NPI number — MR. MEHRDAD M MALEK MD

Table of content: MR. MEHRDAD M MALEK MD (NPI 1992788806)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992788806 NPI number — MR. MEHRDAD M MALEK MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MALEK
Provider First Name:
MEHRDAD
Provider Middle Name:
M
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1992788806
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/15/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8316 ARLINGTON BLVD STE 400
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAIRFAX
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22031-5216
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-641-5633
Provider Business Mailing Address Fax Number:
703-289-1273

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8316 ARLINGTON BLVD
Provider Second Line Business Practice Location Address:
STE 414
Provider Business Practice Location Address City Name:
FAIRFAX
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22031-5207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-641-5633
Provider Business Practice Location Address Fax Number:
703-821-5633
Provider Enumeration Date:
11/23/2005

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: 207X00000X , with the licence number:  0101030924 , 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)

  • Identifier: 0900955 . This is a "UNITED HEALTHCARE OF MID" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 15690001 . This is a "CAREFIRST BLUE SHIELD DC" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 504164 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0900045 . This is a "UNITED HEALTHCARE OF NORT" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 0900129 . This is a "UNITED HEALTHCARE OF MID" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 34037504 . This is a "CAREFIRST MARYLAND" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 0900046 . This is a "UNITED HEALTHCARE OF NORT" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 145854900 . This is a "WORKMANS COMP US DEPT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 456840 . This is a "MEDICARE GROUP" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 070336 . This is a "ANTHEM BLUE SHIELD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 34037503 . This is a "CAREFIRST MARYLAND" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 4053030 . This is a "AETNA PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 021800 . This is a "ANTHEM BLUE SHIELD" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 036107945 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".




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