Provider Demographics
NPI:1114306677
Name:JAZEBI, NOUSHIN (MD)
Entity Type:Individual
Prefix:
First Name:NOUSHIN
Middle Name:
Last Name:JAZEBI
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:BG 10-CRC RM 7-5680 MSC 1404 10 CENTER DRIVE
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20892-1404
Mailing Address - Country:US
Mailing Address - Phone:301-496-5295
Mailing Address - Fax:
Practice Address - Street 1:BG 10-CRC RM 7-5680 MSC 1404 10 CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20892-1404
Practice Address - Country:US
Practice Address - Phone:301-496-5295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-29
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP200579182084N0400X, 2084N0600X
PAMD4681102084N0600X
TXBP10052633207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine