Provider Demographics
NPI:1508021445
Name:GHAZNAVI, AMIR MAHAN (MD)
Entity Type:Individual
Prefix:MR
First Name:AMIR
Middle Name:MAHAN
Last Name:GHAZNAVI
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 1:13454 SUNRISE VALLEY DR STE 130
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20171-3278
Mailing Address - Country:US
Mailing Address - Phone:703-239-3190
Mailing Address - Fax:
Practice Address - Street 1:13454 SUNRISE VALLEY DR STE 130
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20171-3278
Practice Address - Country:US
Practice Address - Phone:703-239-3190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-21
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43011001532086S0122X
390200000X
VA01012733922086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program