1932110269 NPI number — G. REZA MEHRYAR, M.D., NEUROLOGY, P.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932110269 NPI number — G. REZA MEHRYAR, M.D., NEUROLOGY, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
G. REZA MEHRYAR, M.D., NEUROLOGY, P.C.
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:
1932110269
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3650 JOSEPH SIEWICK DR
Provider Second Line Business Mailing Address:
#310
Provider Business Mailing Address City Name:
FAIRFAX
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22033-1710
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-620-2929
Provider Business Mailing Address Fax Number:
703-620-1711

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3650 JOSEPH SIEWICK DR
Provider Second Line Business Practice Location Address:
#310
Provider Business Practice Location Address City Name:
FAIRFAX
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22033-1710
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-620-2929
Provider Business Practice Location Address Fax Number:
703-620-1711
Provider Enumeration Date:
08/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MEHRYAR
Authorized Official First Name:
GHOLAM
Authorized Official Middle Name:
REZA
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
703-620-2929

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X , with the licence number:  22328 , 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: 100305 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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