Provider Demographics
NPI:1275046070
Name:OSTOVAR, ALIREZA (DC)
Entity Type:Individual
Prefix:
First Name:ALIREZA
Middle Name:
Last Name:OSTOVAR
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7610 PENNSYLVANIA AVE STE 303
Mailing Address - Street 2:
Mailing Address - City:FORESTVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20747-4764
Mailing Address - Country:US
Mailing Address - Phone:240-838-3373
Mailing Address - Fax:240-838-3475
Practice Address - Street 1:7610 PENNSYLVANIA AVE STE 303
Practice Address - Street 2:
Practice Address - City:FORESTVILLE
Practice Address - State:MD
Practice Address - Zip Code:20747-4764
Practice Address - Country:US
Practice Address - Phone:240-838-3373
Practice Address - Fax:240-838-3475
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-15
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH12476111N00000X
MDS03919111N00000X
VA0104557391111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty