Provider Demographics
NPI:1497850077
Name:EJTEMAEE, NASRIN (MD)
Entity Type:Individual
Prefix:
First Name:NASRIN
Middle Name:
Last Name:EJTEMAEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8375 GREENSBORO DR # A
Mailing Address - Street 2:
Mailing Address - City:MCLEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-3529
Mailing Address - Country:US
Mailing Address - Phone:703-893-8345
Mailing Address - Fax:703-356-2730
Practice Address - Street 1:8375 GREENSBORO DR # A
Practice Address - Street 2:
Practice Address - City:MCLEAN
Practice Address - State:VA
Practice Address - Zip Code:22102-3529
Practice Address - Country:US
Practice Address - Phone:703-893-8345
Practice Address - Fax:703-356-2730
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101221367207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5642329Medicaid
VA5642329Medicaid
VA490373Medicare PIN