Provider Demographics
NPI:1437237468
Name:REZAZADEH TEHRANI, ALI (MD)
Entity Type:Individual
Prefix:
First Name:ALI
Middle Name:
Last Name:REZAZADEH TEHRANI
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 1:9801 GEORGIA AVE
Mailing Address - Street 2:SUITE 3-41
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-5276
Mailing Address - Country:US
Mailing Address - Phone:301-681-1535
Mailing Address - Fax:301-681-3949
Practice Address - Street 1:9801 GEORGIA AVE
Practice Address - Street 2:SUITE 3-41
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-5276
Practice Address - Country:US
Practice Address - Phone:301-681-1535
Practice Address - Fax:300-168-1394
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0046939174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDP00318367Medicare PIN
MD221P491GMedicare PIN
DCG02229A02Medicare PIN
MDG43302Medicare UPIN