Provider Demographics
NPI:1760458616
Name:MOFID-WOO, FOROUZANDEH FARAH (MD)
Entity Type:Individual
Prefix:DR
First Name:FOROUZANDEH
Middle Name:FARAH
Last Name:MOFID-WOO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:FARAH
Other - Middle Name:F
Other - Last Name:KHAYAT-MOFID
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:12965 HIGHLAND OAKS CT
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-2030
Mailing Address - Country:US
Mailing Address - Phone:703-488-9830
Mailing Address - Fax:
Practice Address - Street 1:201 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046-4518
Practice Address - Country:US
Practice Address - Phone:703-237-4424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101055308207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAG62883Medicare UPIN