Provider Demographics
NPI:1750338505
Name:MAFI, SHAHRYAR (MD)
Entity type:Individual
Prefix:DR
First Name:SHAHRYAR
Middle Name:
Last Name:MAFI
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 1:8100 ASHTON AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20109-5622
Mailing Address - Country:US
Mailing Address - Phone:703-331-0300
Mailing Address - Fax:703-331-0254
Practice Address - Street 1:8100 ASHTON AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-5622
Practice Address - Country:US
Practice Address - Phone:703-331-0300
Practice Address - Fax:703-331-0254
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101055791207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCG00773OtherMEDICARE DC PTAN
VAC09878OtherMEDICARE OF VA PTAN
VAC08583OtherMEDICARE OF VA PTAN
VAC06380OtherMEDICARE OF VA PTAN
VAF72318Medicare UPIN