Provider Demographics
NPI:1598303000
Name:MAHMOUDZADEH, MARYAM
Entity Type:Individual
Prefix:DR
First Name:MARYAM
Middle Name:
Last Name:MAHMOUDZADEH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2474 CURIE CT
Mailing Address - Street 2:
Mailing Address - City:OAK HILL
Mailing Address - State:VA
Mailing Address - Zip Code:20171-6100
Mailing Address - Country:US
Mailing Address - Phone:571-345-6419
Mailing Address - Fax:
Practice Address - Street 1:101 HOSPITAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-6200
Practice Address - Country:US
Practice Address - Phone:540-741-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-16
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA02022134321835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist