Provider Demographics
NPI:1659310043
Name:TEBYANIAN, NAGHMEH (MD)
Entity Type:Individual
Prefix:
First Name:NAGHMEH
Middle Name:
Last Name:TEBYANIAN
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 1:6136 BRANDON AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22150-2610
Mailing Address - Country:US
Mailing Address - Phone:703-866-3131
Mailing Address - Fax:703-866-3133
Practice Address - Street 1:6136 BRANDON AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22150-2610
Practice Address - Country:US
Practice Address - Phone:703-866-3131
Practice Address - Fax:703-866-3133
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101054906207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1659310043Medicaid
VA00X461V01Medicare UPIN
DCG02725V02Medicare UPIN