Provider Demographics
NPI:1336254010
Name:AHMADI, SATAR (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:SATAR
Middle Name:
Last Name:AHMADI
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5255 DUKE ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-2922
Mailing Address - Country:US
Mailing Address - Phone:703-751-7331
Mailing Address - Fax:703-751-2524
Practice Address - Street 1:5255 DUKE ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-2922
Practice Address - Country:US
Practice Address - Phone:703-751-7331
Practice Address - Fax:703-751-2524
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101041949207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F19401Medicare UPIN
767039Medicare ID - Type Unspecified