Provider Demographics
NPI:1033194584
Name:GHORBANI, REZA (MD)
Entity Type:Individual
Prefix:DR
First Name:REZA
Middle Name:
Last Name:GHORBANI
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:PO BOX 71155
Mailing Address - Street 2:
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20813-1155
Mailing Address - Country:US
Mailing Address - Phone:301-220-1333
Mailing Address - Fax:240-539-2533
Practice Address - Street 1:7501 GREENWAY CENTER DR
Practice Address - Street 2:SUITE 660
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-3514
Practice Address - Country:US
Practice Address - Phone:301-220-1333
Practice Address - Fax:240-539-2533
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA82190207L00000X, 208VP0014X
MDD0065935207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3169421Medicaid
MA3169421Medicaid
MD6157240001Medicare NSC
MDA22621Medicare PIN