Provider Demographics
NPI:1114510955
Name:ALIMI, MARIAM (NP)
Entity Type:Individual
Prefix:
First Name:MARIAM
Middle Name:
Last Name:ALIMI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13050 GREG ROY LN
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20171-5352
Mailing Address - Country:US
Mailing Address - Phone:703-273-0001
Mailing Address - Fax:
Practice Address - Street 1:10560 MAIN ST STE 307
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-7175
Practice Address - Country:US
Practice Address - Phone:703-273-0001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-12
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024180944207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty