Provider Demographics
NPI:1619963139
Name:MOAZZEZ, AMIR HOUSHANG (MD)
Entity Type:Individual
Prefix:DR
First Name:AMIR
Middle Name:HOUSHANG
Last Name:MOAZZEZ
Suffix:
Gender:M
Credentials:MD
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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 1:3620 JOSEPH SIEWICK DRIVE
Practice Address - Street 2:SUITE 200
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033
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
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Provider Licenses
StateLicense IDTaxonomies
VA0101235385208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
H44903Medicare UPIN
DC491788Medicare PIN