Provider Demographics
NPI:1598821449
Name:REZAIAN, MICHAEL MOHAMMAD (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:MOHAMMAD
Last Name:REZAIAN
Suffix:
Gender:M
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:PO BOX 1236
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20167-8415
Mailing Address - Country:US
Mailing Address - Phone:304-262-0085
Mailing Address - Fax:304-262-0356
Practice Address - Street 1:2010 DOCTOR OATES DR
Practice Address - Street 2:SUITE 104
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-8896
Practice Address - Country:US
Practice Address - Phone:304-262-0085
Practice Address - Fax:304-262-0356
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV16112207R00000X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0081978000Medicaid
VA466846OtherANTHEM BLUE CROSS
E65375Medicare UPIN
WV9330051Medicare ID - Type Unspecified