Provider Demographics
NPI:1740277748
Name:DEHESH, TAHMOURES (MD)
Entity type:Individual
Prefix:DR
First Name:TAHMOURES
Middle Name:
Last Name:DEHESH
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:PO BOX 1400
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22038-1400
Mailing Address - Country:US
Mailing Address - Phone:703-383-9543
Mailing Address - Fax:703-383-9532
Practice Address - Street 1:1160 VARNUM ST NE
Practice Address - Street 2:#218
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-2107
Practice Address - Country:US
Practice Address - Phone:202-526-2800
Practice Address - Fax:202-832-0064
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-04
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD304861207RG0100X
DCMD034861207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC036734600Medicaid
DC491997Medicare ID - Type UnspecifiedDC MEDICARE
I30285Medicare UPIN