Provider Demographics
NPI:1114121142
Name:DJAFARI, PARIA (MD)
Entity Type:Individual
Prefix:
First Name:PARIA
Middle Name:
Last Name:DJAFARI
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:PO BOX 17334
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-1334
Mailing Address - Country:US
Mailing Address - Phone:703-443-6717
Mailing Address - Fax:703-443-8643
Practice Address - Street 1:44084 RIVERSIDE PKWY
Practice Address - Street 2:SUITE300
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-5102
Practice Address - Country:US
Practice Address - Phone:703-724-7530
Practice Address - Fax:703-858-2880
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101243008207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1114121142Medicaid
VA1114121142Medicaid