Provider Demographics
NPI:1023110426
Name:NEJAD, GHASSEM A (MD)
Entity type:Individual
Prefix:
First Name:GHASSEM
Middle Name:A
Last Name:NEJAD
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 1:2020 OPTIZ BLVD
Mailing Address - Street 2:B
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191
Mailing Address - Country:US
Mailing Address - Phone:703-690-2970
Mailing Address - Fax:703-690-0895
Practice Address - Street 1:2020 OPTIZ BLVD
Practice Address - Street 2:B
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191
Practice Address - Country:US
Practice Address - Phone:703-690-2970
Practice Address - Fax:703-690-0895
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101021336207X00000X, 207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
C61470Medicare UPIN
VA0200000698Medicare NSC
VA0000006313Medicare NSC