Provider Demographics
NPI:1831772409
Name:GOLDBERG, AZADEH PAJOOHESH
Entity type:Individual
Prefix:
First Name:AZADEH
Middle Name:PAJOOHESH
Last Name:GOLDBERG
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 BEVERLY RD STE 3001420
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-3732
Mailing Address - Country:US
Mailing Address - Phone:703-852-8588
Mailing Address - Fax:
Practice Address - Street 1:1420 BEVERLY RD STE 3001420
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-3732
Practice Address - Country:US
Practice Address - Phone:703-852-8588
Practice Address - Fax:410-354-7942
Is Sole Proprietor?:No
Enumeration Date:2021-05-03
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024181276163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse