Provider Demographics
NPI:1033230453
Name:SADEGHIAN, IRADJ NMI (MD)
Entity Type:Individual
Prefix:DR
First Name:IRADJ
Middle Name:NMI
Last Name:SADEGHIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4744 NEPTUNE DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22309-3133
Mailing Address - Country:US
Mailing Address - Phone:301-839-0100
Mailing Address - Fax:301-839-7434
Practice Address - Street 1:6130 OXON HILL RD
Practice Address - Street 2:SUITE 301
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-3103
Practice Address - Country:US
Practice Address - Phone:301-839-0100
Practice Address - Fax:301-839-7434
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0016094207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDB93158Medicare UPIN
MD142323Medicare ID - Type Unspecified