Provider Demographics
NPI:1306207238
Name:HADDADI-SAHNEH, BEHNAZ (MD)
Entity Type:Individual
Prefix:
First Name:BEHNAZ
Middle Name:
Last Name:HADDADI-SAHNEH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13135 LEE JACKSON MEMORIAL HWY STE 135
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-1907
Mailing Address - Country:US
Mailing Address - Phone:703-961-0488
Mailing Address - Fax:
Practice Address - Street 1:13135 LEE JACKSON MEMORIAL HWY STE 135
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-1907
Practice Address - Country:US
Practice Address - Phone:703-961-0488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-20
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD047136207R00000X
VA0101271368207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0101271368OtherVIRGINIA MEDICAL BOARD STATE LICENSE
DCMD047136OtherDISTRICT OF COLUMBIA BOARD OF MEDICINE