Provider Demographics
NPI:1609847060
Name:EMAMIAN, SEYED A (MD , PH D)
Entity Type:Individual
Prefix:
First Name:SEYED
Middle Name:A
Last Name:EMAMIAN
Suffix:
Gender:M
Credentials:MD , PH D
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 9007
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22906-9007
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:LEE ST FL 1
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22908-0001
Practice Address - Country:US
Practice Address - Phone:434-243-0630
Practice Address - Fax:434-982-1618
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00554022085R0202X
VA01012221042085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDCN2566OtherMEDICARE RR
MD118303600Medicaid
MDCD4495OtherMEDICARE RR
MDKA80OtherB/C B/S
DC2849OtherB/C B/S
NY906S2WQ111OtherMEDICARE
DEDD4343OtherMEDICARE RR
MDJ062OtherB/C B/S
DCG00000019190A00Medicare PIN
MDJ062OtherB/C B/S
MDCN2566OtherMEDICARE RR
FMX026Medicare PIN
NY906S2WQ111OtherMEDICARE
DC2849OtherB/C B/S
MD118303600Medicaid
MD435LA549Medicare PIN