Provider Demographics
NPI:1417201401
Name:RAHIMI, SHIRZAD ALEXDANDROS (CSA)
Entity Type:Individual
Prefix:
First Name:SHIRZAD
Middle Name:ALEXDANDROS
Last Name:RAHIMI
Suffix:
Gender:M
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14701 LEE HWY
Mailing Address - Street 2:SUITE 303
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20121-2137
Mailing Address - Country:US
Mailing Address - Phone:301-502-9680
Mailing Address - Fax:
Practice Address - Street 1:14701 LEE HIGHWAY
Practice Address - Street 2:SUITE 303
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20121-2137
Practice Address - Country:US
Practice Address - Phone:301-502-9680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-30
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0000000000OtherBCBS, CIGNA, UNITED HEALTHCARE, CARE FIRST