Provider Demographics
NPI:1467644310
Name:JASMINE MOGHISSI, M.D., P.C.
Entity Type:Organization
Organization Name:JASMINE MOGHISSI, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JASMINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOGHISSI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-281-5560
Mailing Address - Street 1:9401 LEE HWY
Mailing Address - Street 2:SUITE 302
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-1849
Mailing Address - Country:US
Mailing Address - Phone:703-281-5560
Mailing Address - Fax:703-281-5568
Practice Address - Street 1:9401 LEE HWY
Practice Address - Street 2:SUITE 302
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-1849
Practice Address - Country:US
Practice Address - Phone:703-281-5560
Practice Address - Fax:703-281-5568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-15
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101044043207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DF2854 / P00353016OtherMEDICARE RAILROAD
DF2854 / P00353016OtherMEDICARE RAILROAD
E40807Medicare UPIN