Provider Demographics
NPI:1356773048
Name:HOUSHANG MAKIPOUR, MD PC
Entity type:Organization
Organization Name:HOUSHANG MAKIPOUR, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:SACKRIDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-580-7433
Mailing Address - Street 1:2280 OPITZ BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-3362
Mailing Address - Country:US
Mailing Address - Phone:703-580-7433
Mailing Address - Fax:703-580-7437
Practice Address - Street 1:2280 OPITZ BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-3362
Practice Address - Country:US
Practice Address - Phone:703-580-7433
Practice Address - Fax:703-580-7437
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOUSHANG MAKIPOUR, MD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-08-05
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty