Provider Demographics
NPI:1710957899
Name:MOLAIY, JOHN HOSSEIN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:HOSSEIN
Last Name:MOLAIY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1635 N GEORGE MASON DR
Mailing Address - Street 2:SUITE 455
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22205-3601
Mailing Address - Country:US
Mailing Address - Phone:703-465-0137
Mailing Address - Fax:703-465-0429
Practice Address - Street 1:1635 N GEORGE MASON DR
Practice Address - Street 2:SUITE 455
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22205-3601
Practice Address - Country:US
Practice Address - Phone:703-465-0137
Practice Address - Fax:703-465-0429
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101232384207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAG873-0001OtherBLUE CROSS BLUE SHIELD
VA3051452OtherAETNA
VA010000645Medicaid
VA2104198OtherMAMSI
VAH58879Medicare UPIN
VA2104198OtherMAMSI