Provider Demographics
NPI:1003312729
Name:NIA, BENJAMIN BEHNOUD (MD)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:BEHNOUD
Last Name:NIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 MASSACHUSETTS AVE NW APT 1017
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20005-5331
Mailing Address - Country:US
Mailing Address - Phone:328-636-3958
Mailing Address - Fax:
Practice Address - Street 1:3700 JOSEPH SIEWICK DR STE 302
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-1739
Practice Address - Country:US
Practice Address - Phone:703-648-2488
Practice Address - Fax:703-648-2489
Is Sole Proprietor?:No
Enumeration Date:2018-04-02
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101275514207N00000X
TXBP10063399207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program