Provider Demographics
NPI:1952643728
Name:RAHNEMA, MANSUR (MD)
Entity Type:Individual
Prefix:DR
First Name:MANSUR
Middle Name:
Last Name:RAHNEMA
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 1:47340 BLACKWATER FALLS TER
Mailing Address - Street 2:47340 BLACKWATER FALLS TERRACE
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20165-2492
Mailing Address - Country:US
Mailing Address - Phone:703-444-6624
Mailing Address - Fax:703-444-6624
Practice Address - Street 1:47340 BLACKWATER FALLS TER
Practice Address - Street 2:47340 BLACKWATER FALLS TERRACE
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20165-2492
Practice Address - Country:US
Practice Address - Phone:703-444-6624
Practice Address - Fax:703-444-6624
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-20
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101020648208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice