Provider Demographics
NPI:1659423648
Name:DOCTOR AMIR MIRZAALIKHANI, PA
Entity Type:Organization
Organization Name:DOCTOR AMIR MIRZAALIKHANI, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AMIR
Authorized Official - Middle Name:M
Authorized Official - Last Name:ALIKHANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-983-6656
Mailing Address - Street 1:8578 BRICKYARD RD
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-4833
Mailing Address - Country:US
Mailing Address - Phone:301-983-6656
Mailing Address - Fax:301-983-8110
Practice Address - Street 1:101 CENTENNIAL ST STE B
Practice Address - Street 2:
Practice Address - City:LA PLATA
Practice Address - State:MD
Practice Address - Zip Code:20646-5976
Practice Address - Country:US
Practice Address - Phone:301-934-6060
Practice Address - Fax:301-934-4523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0026262207RC0200X
MDD0046046207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD403163600Medicaid
MD403163600Medicaid