Provider Demographics
NPI:1467734301
Name:MOMENZADEH, EILNAZ (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:EILNAZ
Middle Name:
Last Name:MOMENZADEH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3414 OLANDWOOD CT
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-1384
Mailing Address - Country:US
Mailing Address - Phone:301-774-0500
Mailing Address - Fax:301-774-7338
Practice Address - Street 1:3414 OLANDWOOD CT
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832
Practice Address - Country:US
Practice Address - Phone:301-774-0500
Practice Address - Fax:301-774-7338
Is Sole Proprietor?:No
Enumeration Date:2011-09-16
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0004214363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical