Provider Demographics
NPI:1386684694
Name:TABANDEH, HASSAN (MD)
Entity Type:Individual
Prefix:
First Name:HASSAN
Middle Name:
Last Name:TABANDEH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 N GEORGE MASON DR
Mailing Address - Street 2:SUITE 354
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22205-3683
Mailing Address - Country:US
Mailing Address - Phone:703-717-7780
Mailing Address - Fax:703-717-7781
Practice Address - Street 1:1625 N GEORGE MASON DR
Practice Address - Street 2:SUITE 354
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22205-3683
Practice Address - Country:US
Practice Address - Phone:703-717-7780
Practice Address - Fax:703-717-7781
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2021-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101234981207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1386684694Medicaid
VAH93564Medicare UPIN
133947YD70Medicare PIN
VAC08583OtherMANASSAS HEART CENTER
VA002630V80Medicare ID - Type UnspecifiedPROVIDER
VA10007429Medicaid
C09878OtherWARRENTON HEART CENTER