Provider Demographics
NPI:1407082019
Name:BEHNAZ FAYAZI, M.D.,LLC.
Entity Type:Organization
Organization Name:BEHNAZ FAYAZI, M.D.,LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:BEHNAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:FAYAZI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-525-9994
Mailing Address - Street 1:11221 MITSCHER ST
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895-1329
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:301-263-7141
Practice Address - Street 1:5530 WISCONSIN AVE
Practice Address - Street 2:SUITE 1248
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-4404
Practice Address - Country:US
Practice Address - Phone:301-525-9994
Practice Address - Fax:301-263-7141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-09
Last Update Date:2009-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD000686492086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty