Provider Demographics
NPI:1508213877
Name:MARYAM MAHMOODIAN, MD FAMILY MEDICINE LLC
Entity Type:Organization
Organization Name:MARYAM MAHMOODIAN, MD FAMILY MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MARYAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHMOODIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-209-0287
Mailing Address - Street 1:2015 RESERVOIR ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-8781
Mailing Address - Country:US
Mailing Address - Phone:540-209-0287
Mailing Address - Fax:
Practice Address - Street 1:2015 RESERVOIR ST
Practice Address - Street 2:SUITE 203
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-8781
Practice Address - Country:US
Practice Address - Phone:540-209-0287
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-17
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101255978207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty