1881669919 NPI number — MARYAM ZAMANI, M.D., PC

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 1881669919 NPI number — MARYAM ZAMANI, M.D., PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARYAM ZAMANI, M.D., PC
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:
1881669919
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:
3229 WOODBURN RD
Provider Second Line Business Mailing Address:
STE 350
Provider Business Mailing Address City Name:
ANNANDALE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22003-1274
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-848-8202
Provider Business Mailing Address Fax Number:
410-848-2644

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3229 WOODBURN RD
Provider Second Line Business Practice Location Address:
STE 350
Provider Business Practice Location Address City Name:
ANNANDALE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22003-1274
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-848-8202
Provider Business Practice Location Address Fax Number:
410-848-2644
Provider Enumeration Date:
02/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ZAMANI
Authorized Official First Name:
MARYAM
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
410-848-8202

Provider Taxonomy Codes

  • Taxonomy code: 152WC0802X , with the licence number:  0101237180 , 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: K711 . This is a "FEDERAL BLUE CROSS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 179791 . This is a "BC/BS OF VIRGINIA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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