Provider Demographics
NPI:1942326251
Name:TAJKARIMI, KAMBIZ (MD)
Entity Type:Individual
Prefix:DR
First Name:KAMBIZ
Middle Name:
Last Name:TAJKARIMI
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 1:44055 RIVERSIDE PKWY STE 208
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-5176
Mailing Address - Country:US
Mailing Address - Phone:703-687-3601
Mailing Address - Fax:703-687-3602
Practice Address - Street 1:44055 RIVERSIDE PKWY STE 208
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-5176
Practice Address - Country:US
Practice Address - Phone:703-687-3601
Practice Address - Fax:703-687-3602
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101257572208800000X
DCMD036391208800000X
PAMD433444208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA867633OtherMEDICARE GROUP #
PA1021322530002Medicaid
PA130614LN7Medicare PIN