Provider Demographics
NPI:1023066362
Name:DADGAR, ANUSHIRAVAN (DO)
Entity type:Individual
Prefix:
First Name:ANUSHIRAVAN
Middle Name:
Last Name:DADGAR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10110 MOLECULAR DRIVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-7542
Mailing Address - Country:US
Mailing Address - Phone:301-343-6505
Mailing Address - Fax:240-403-0190
Practice Address - Street 1:10110 MOLECULAR DR
Practice Address - Street 2:SUITE 206
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-7539
Practice Address - Country:US
Practice Address - Phone:301-279-2779
Practice Address - Fax:240-403-0190
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH0051280207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD351201100Medicaid
DC00A761M50Medicare ID - Type Unspecified
G73519Medicare UPIN