Provider Demographics
NPI:1811171747
Name:IRADJ SADEGHIAN MD & ASSOCIATES
Entity type:Organization
Organization Name:IRADJ SADEGHIAN MD & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IRADJ
Authorized Official - Middle Name:NMI
Authorized Official - Last Name:SADEGHIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-839-0100
Mailing Address - Street 1:6130 OXON HILL ROAD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:OXON HILL
Mailing Address - State:MD
Mailing Address - Zip Code:20745-3168
Mailing Address - Country:US
Mailing Address - Phone:301-839-0100
Mailing Address - Fax:301-839-7434
Practice Address - Street 1:6130 OXON HILL RD
Practice Address - Street 2:SUITE 301
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-3103
Practice Address - Country:US
Practice Address - Phone:301-839-0100
Practice Address - Fax:301-839-7434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD16094207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD113071400Medicaid
142323Medicare PIN
MD113071400Medicaid