Provider Demographics
NPI:1225724610
Name:ALLEVIUS CLINIC
Entity Type:Organization
Organization Name:ALLEVIUS CLINIC
Other - Org Name:ALLEVIUS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MEHRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BAJOGHLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:276-500-0338
Mailing Address - Street 1:1570 ONYX DR UNIT 305
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-3957
Mailing Address - Country:US
Mailing Address - Phone:276-500-0338
Mailing Address - Fax:
Practice Address - Street 1:1570 ONYX DR UNIT 305
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22102-3957
Practice Address - Country:US
Practice Address - Phone:276-500-0338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-18
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207U00000XAllopathic & Osteopathic PhysiciansNuclear MedicineGroup - Multi-Specialty