Provider Demographics
NPI:1619993086
Name:OLSEN, RAENA SADEGHI (DO)
Entity Type:Individual
Prefix:DR
First Name:RAENA
Middle Name:SADEGHI
Last Name:OLSEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:NASIM
Other - Middle Name:RAENA
Other - Last Name:SADEGHI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:7215 DELFIELD ST
Mailing Address - Street 2:
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-4045
Mailing Address - Country:US
Mailing Address - Phone:310-990-1390
Mailing Address - Fax:
Practice Address - Street 1:12012 VEIRS MILL RD
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20906-4513
Practice Address - Country:US
Practice Address - Phone:301-942-3550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2023-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB07776800207R00000X
CA20A 9684207RG0100X
MDH0092224207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJI42525Medicare UPIN