Provider Demographics
NPI:1609019520
Name:KAZEMI, ALI FARHAD (MD)
Entity Type:Individual
Prefix:
First Name:ALI
Middle Name:FARHAD
Last Name:KAZEMI
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 1:14010 SMOKETOWN RD
Mailing Address - Street 2:SUITE 117
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-4722
Mailing Address - Country:US
Mailing Address - Phone:703-580-0181
Mailing Address - Fax:
Practice Address - Street 1:14010 SMOKETOWN RD
Practice Address - Street 2:SUITE 117
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-4722
Practice Address - Country:US
Practice Address - Phone:703-580-0181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-07
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101258470207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology