Provider Demographics
NPI:1376836668
Name:DAMAVANDY, ALI A (MD)
Entity Type:Individual
Prefix:DR
First Name:ALI
Middle Name:A
Last Name:DAMAVANDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6711 WHITTIER AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-4540
Mailing Address - Country:US
Mailing Address - Phone:703-798-0610
Mailing Address - Fax:833-550-1728
Practice Address - Street 1:6711 WHITTIER AVE STE 101
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-4540
Practice Address - Country:US
Practice Address - Phone:703-992-9211
Practice Address - Fax:833-550-1728
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-19
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101260257207ND0101X, 207ND0101X
PAMD454457207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology