Provider Demographics
NPI:1033128798
Name:GHASEMZADEH, ROKSANA (MD)
Entity Type:Individual
Prefix:MRS
First Name:ROKSANA
Middle Name:
Last Name:GHASEMZADEH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1581 SPRING GATE DR UNIT 5412
Mailing Address - Street 2:
Mailing Address - City:MCLEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-3442
Mailing Address - Country:US
Mailing Address - Phone:703-855-4167
Mailing Address - Fax:
Practice Address - Street 1:14573 POTOMAC MILLS RD
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-6808
Practice Address - Country:US
Practice Address - Phone:703-497-1234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101233103174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist