Provider Demographics
NPI:1639205826
Name:MAJLESSI, SUSAN (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:MAJLESSI
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:9010 LORTON STATION BLVD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:LORTON
Mailing Address - State:VA
Mailing Address - Zip Code:22079-4792
Mailing Address - Country:US
Mailing Address - Phone:571-285-2020
Mailing Address - Fax:855-285-2022
Practice Address - Street 1:9010 LORTON STATION BLVD
Practice Address - Street 2:SUITE 250
Practice Address - City:LORTON
Practice Address - State:VA
Practice Address - Zip Code:22079-4792
Practice Address - Country:US
Practice Address - Phone:571-285-2020
Practice Address - Fax:855-285-2022
Is Sole Proprietor?:No
Enumeration Date:2007-02-24
Last Update Date:2016-07-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101241019207W00000X, 207W00000X
MDD0066577207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1639205826Medicare PIN