Provider Demographics
NPI:1720239775
Name:TAYMOUR, ARYAN KURDISTAN (PA)
Entity Type:Individual
Prefix:
First Name:ARYAN
Middle Name:KURDISTAN
Last Name:TAYMOUR
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7610 CARROLL AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-6384
Mailing Address - Country:US
Mailing Address - Phone:301-891-2500
Mailing Address - Fax:301-448-1679
Practice Address - Street 1:7610 CARROLL AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-6384
Practice Address - Country:US
Practice Address - Phone:301-891-2500
Practice Address - Fax:301-448-1679
Is Sole Proprietor?:No
Enumeration Date:2008-10-08
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0006097363A00000X
MI5601005334363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical