Provider Demographics
NPI:1619058674
Name:SHAHIDI, FIROOZEH HOSSEINI (MD)
Entity Type:Individual
Prefix:
First Name:FIROOZEH
Middle Name:HOSSEINI
Last Name:SHAHIDI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 PARK AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22046
Mailing Address - Country:US
Mailing Address - Phone:703-533-3010
Mailing Address - Fax:703-538-4316
Practice Address - Street 1:313 PARK AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046
Practice Address - Country:US
Practice Address - Phone:703-533-3010
Practice Address - Fax:703-538-4316
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101047063207RE0101X
MDD0039885207RE0101X
DCMD19613207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6006892Medicaid
E57384Medicare UPIN
VA6006892Medicaid