Provider Demographics
NPI:1275586190
Name:BAJOGHLI, AMIR (MD)
Entity Type:Individual
Prefix:DR
First Name:AMIR
Middle Name:
Last Name:BAJOGHLI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1359 BEVERLY RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-3666
Mailing Address - Country:US
Mailing Address - Phone:703-893-1114
Mailing Address - Fax:703-893-4449
Practice Address - Street 1:1359 BEVERLY RD
Practice Address - Street 2:SUITE 200
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-3666
Practice Address - Country:US
Practice Address - Phone:703-893-1114
Practice Address - Fax:703-893-4449
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2014-08-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101053252207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAG45977Medicare UPIN