Provider Demographics
NPI:1881669919
Name:MARYAM ZAMANI, M.D., PC
Entity Type:Organization
Organization Name:MARYAM ZAMANI, M.D., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARYAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAMANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PC
Authorized Official - Phone:410-848-8202
Mailing Address - Street 1:3229 WOODBURN RD
Mailing Address - Street 2:STE 350
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-1274
Mailing Address - Country:US
Mailing Address - Phone:410-848-8202
Mailing Address - Fax:410-848-2644
Practice Address - Street 1:3229 WOODBURN RD
Practice Address - Street 2:STE 350
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-1274
Practice Address - Country:US
Practice Address - Phone:410-848-8202
Practice Address - Fax:410-848-2644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101237180152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAK711OtherFEDERAL BLUE CROSS
VA179791OtherBC/BS OF VIRGINIA
VA26912Medicare UPIN
VA179791OtherBC/BS OF VIRGINIA