1295773679 NPI number — DR. HAMID TAHERI MD

Table of content: DR. HAMID TAHERI MD (NPI 1295773679)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295773679 NPI number — DR. HAMID TAHERI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TAHERI
Provider First Name:
HAMID
Provider Middle Name:
Provider Name Prefix Text:
DR.
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:
1295773679
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/16/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8100 ASHTON AVE
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
MANASSAS
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20109-5622
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-331-0300
Provider Business Mailing Address Fax Number:
703-331-0254

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8100 ASHTON AVE
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
MANASSAS
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20109-5622
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-335-8750
Provider Business Practice Location Address Fax Number:
703-331-0254
Provider Enumeration Date:
06/04/2006

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: 207RC0000X , with the licence number:  101052820 , 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: 10389795 . This is a "CAQH NUMBER" identifier , issued by the state of ( VI ) . This identifiers is of the category "OTHER".
  • Identifier: 204262266 . This is a "TAX ID WARRENTON HEART" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 2500136 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 2501051 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 317184 . This is a "ANTHEM PROVIDER NUMBER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: C08583 . This is a "MEDICARE ID GROUP MANASSAS HEART" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 541984220 . This is a "TAX ID FOR VIRGINIA CARDI" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 70670001 . This is a "CAREFIRST PROVIDER NUMBER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: C06380 . This is a "PALMETTO MEDICARE GROUP PTAN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 00A988V73 . This is a "NOVITAS MEDICARE INDIVIDUAL PTAN" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 505405 . This is a "NCPPO PROVIDER NUMBER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 7602707 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 060001022 . This is a "PALMETTO MEDICARE OF VIRGINIA INDIVDUAL PTAN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 481440 . This is a "OPT/MAMSI/MDIPA NUMBER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 7135122 . This is a "AETNA PPO PROVIDER NUMBER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 154789 . This is a "SOUTHERN HEALTH NUMBER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: C09878 . This is a "MEDICARE ID GROUP WARRENTON HEART" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: G00773 . This is a "NOVITAS MEDICARE GROUP PTAN" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 2337135 . This is a "AETNA HMO PROVIDER NUMBER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 562289471 . This is a "TAX ID FOR MANASSAS HEART" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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