1912124983 NPI number — DR. NAVID MOSTOFI MD

Table of content: DR. NAVID MOSTOFI MD (NPI 1912124983)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912124983 NPI number — DR. NAVID MOSTOFI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOSTOFI
Provider First Name:
NAVID
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:
1912124983
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/21/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 11922
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:
20008-9122
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-652-0948
Provider Business Mailing Address Fax Number:
703-542-3584

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
380 MAPLE AVENUE WEST
Provider Second Line Business Practice Location Address:
SUITE# 206
Provider Business Practice Location Address City Name:
VIENNA
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22180-5620
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-652-0948
Provider Business Practice Location Address Fax Number:
703-542-3584
Provider Enumeration Date:
04/19/2007

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: 2084N0400X , with the licence number:  D0065670 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X , with the licence number: 0101248683 , 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: 0501704 . This is a "EVERCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3167780 . This is a "MAMSI MDIPA OCI" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 89774901 . This is a "BCBS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 0007 . This is a "BCBS" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 4900003 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00443882 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7676965 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".




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