Provider Demographics
NPI:1982667580
Name:RAHMAN, SHAHZAD (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAHZAD
Middle Name:
Last Name:RAHMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SHAHZAD
Other - Middle Name:
Other - Last Name:RAHMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8340 GREENSBORO DR UNIT 120
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-3535
Mailing Address - Country:US
Mailing Address - Phone:703-200-1721
Mailing Address - Fax:703-521-6342
Practice Address - Street 1:THE RENASCENCE CENTER
Practice Address - Street 2:46 S GLEBE ROAD, SUITE 103
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22204
Practice Address - Country:US
Practice Address - Phone:703-521-6004
Practice Address - Fax:703-521-6342
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010518722084P0800X
MDD470332084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD64888803OtherTAX ID #52-2349362 BCBS
VA010257697Medicaid
DCS288-0005OtherFOR TAX ID #52-2349362