Provider Demographics
NPI:1598751117
Name:POURSHOJAE, HAMID REZA (DO)
Entity Type:Individual
Prefix:DR
First Name:HAMID
Middle Name:REZA
Last Name:POURSHOJAE
Suffix:
Gender:M
Credentials:DO
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 205
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:703-620-3211
Mailing Address - Fax:703-620-3215
Practice Address - Street 1:3580 JOSEPH SIEWICK DR STE 205
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:703-620-3211
Practice Address - Fax:703-620-3215
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2023-11-27
Deactivation Date:2006-03-24
Deactivation Code:
Reactivation Date:2006-04-03
Provider Licenses
StateLicense IDTaxonomies
VA0102201710208600000X
AZ3789208600000X
CA20A8669208600000X
MDH0062701208600000X
VA0101239611208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAH66317Medicare UPIN
VA013409D28Medicare PIN
H66317Medicare UPIN