Provider Demographics
NPI:1942963483
Name:ABEDINZADEH, NADER
Entity Type:Individual
Prefix:
First Name:NADER
Middle Name:
Last Name:ABEDINZADEH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20701 ASHBURN VALLEY CT
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-4660
Mailing Address - Country:US
Mailing Address - Phone:571-430-9558
Mailing Address - Fax:
Practice Address - Street 1:19465 DEERFIELD AVE STE 107
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-1702
Practice Address - Country:US
Practice Address - Phone:703-726-2800
Practice Address - Fax:703-723-2500
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-21
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202011595183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist