Provider Demographics
NPI:1578701249
Name:ARDESTANI, AFROOZ (MD)
Entity Type:Individual
Prefix:
First Name:AFROOZ
Middle Name:
Last Name:ARDESTANI
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 1:3580 JOSEPH SIEWICK DR STE 401
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-1764
Mailing Address - Country:US
Mailing Address - Phone:703-391-4140
Mailing Address - Fax:703-391-4148
Practice Address - Street 1:3580 JOSEPH SIEWICK DR STE 401
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-1764
Practice Address - Country:US
Practice Address - Phone:703-391-4140
Practice Address - Fax:703-391-4148
Is Sole Proprietor?:No
Enumeration Date:2009-02-03
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT047642207R00000X
CT390200000X
VA0101256998207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001476423Medicaid