Provider Demographics
NPI:1841412012
Name:FAYAZI, BEHNAZ (MD)
Entity Type:Individual
Prefix:
First Name:BEHNAZ
Middle Name:
Last Name:FAYAZI
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 1:8401 CONNECTICUT AVE
Mailing Address - Street 2:STE 107
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-5827
Mailing Address - Country:US
Mailing Address - Phone:301-215-7550
Mailing Address - Fax:301-263-7141
Practice Address - Street 1:5530 WISCONSIN AVE
Practice Address - Street 2:SUITE 1135
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-4404
Practice Address - Country:US
Practice Address - Phone:301-525-9994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00686492086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery