Provider Demographics
NPI:1851458426
Name:MASOOM M KANDAHARI MD PC
Entity Type:Organization
Organization Name:MASOOM M KANDAHARI MD PC
Other - Org Name:CANCER AND BLOOD SPECIALISTS OF NORTHERN VA PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MASOOM
Authorized Official - Middle Name:M
Authorized Official - Last Name:KANDAHARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-590-8300
Mailing Address - Street 1:2280 OPITZ BLVD
Mailing Address - Street 2:STE 220
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-3362
Mailing Address - Country:US
Mailing Address - Phone:703-590-8300
Mailing Address - Fax:703-590-8301
Practice Address - Street 1:2280 OPITZ BLVD
Practice Address - Street 2:STE 220
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-3362
Practice Address - Country:US
Practice Address - Phone:703-590-8300
Practice Address - Fax:703-590-8301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA61950001OtherKANDAHARI BCBS
VA1760415269OtherCAFFEY INDIVIDUAL NPI
VA1467448100OtherKANDAHARI INDIVIDUAL NPI
VA61950001OtherKANDAHARI BCBS
DCG01645Medicare ID - Type UnspecifiedMEDICARE GRP NUMBER ARLIN
VA1760415269OtherCAFFEY INDIVIDUAL NPI