Provider Demographics
NPI:1437503976
Name:MAMMADOVA, AYTAN (MD)
Entity Type:Individual
Prefix:
First Name:AYTAN
Middle Name:
Last Name:MAMMADOVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AYTAN
Other - Middle Name:
Other - Last Name:SANIEV
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8101 HINSON FARM RD STE 219
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22306-3406
Mailing Address - Country:US
Mailing Address - Phone:703-360-8383
Mailing Address - Fax:703-360-0263
Practice Address - Street 1:8101 HINSON FARM RD STE 219
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306-3406
Practice Address - Country:US
Practice Address - Phone:703-360-8383
Practice Address - Fax:703-360-0263
Is Sole Proprietor?:No
Enumeration Date:2016-04-21
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD047023207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism