Provider Demographics
NPI:1164519310
Name:VIRGINIA PULMONARY ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:VIRGINIA PULMONARY ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES/VP/SEC/TRES
Authorized Official - Prefix:
Authorized Official - First Name:ALA
Authorized Official - Middle Name:S
Authorized Official - Last Name:MORTAZAVI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-497-0212
Mailing Address - Street 1:313 PARK AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22046-3303
Mailing Address - Country:US
Mailing Address - Phone:703-497-0212
Mailing Address - Fax:
Practice Address - Street 1:313 PARK AVE STE 202
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046-3303
Practice Address - Country:US
Practice Address - Phone:703-497-0212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VIRGINIA PULMONARY ASSOCIATES, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-09
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC12825OtherRAIL ROAD MEDICARE GRP
DCG00110Medicare PIN