Provider Demographics
NPI:1629259247
Name:IRADJ DADGAR MD PC
Entity Type:Organization
Organization Name:IRADJ DADGAR MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IRADJ
Authorized Official - Middle Name:
Authorized Official - Last Name:DADGAR DEHKORDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:240-403-3322
Mailing Address - Street 1:PO BOX 1625
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20849-1625
Mailing Address - Country:US
Mailing Address - Phone:240-403-3322
Mailing Address - Fax:301-983-4285
Practice Address - Street 1:7801 OLD BRANCH AVE
Practice Address - Street 2:SUITE 409
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-1608
Practice Address - Country:US
Practice Address - Phone:240-403-3320
Practice Address - Fax:301-983-4285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-26
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0014827208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
B93373Medicare UPIN
MD338MMedicare PIN