Provider Demographics
NPI:1598347924
Name:MAJESTIC MEDICAL ASSOCIATION LLC
Entity Type:Organization
Organization Name:MAJESTIC MEDICAL ASSOCIATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:BARDIA
Authorized Official - Last Name:NEMATI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-966-3542
Mailing Address - Street 1:PO BOX 9611
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-0611
Mailing Address - Country:US
Mailing Address - Phone:818-966-3542
Mailing Address - Fax:
Practice Address - Street 1:9401 LEE HWY STE 400
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-1847
Practice Address - Country:US
Practice Address - Phone:703-383-4836
Practice Address - Fax:844-334-9826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-26
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty