Provider Demographics
NPI:1841254265
Name:POOYAN, PAYAM (MD)
Entity type:Individual
Prefix:DR
First Name:PAYAM
Middle Name:
Last Name:POOYAN
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 1:19455 DEERFIELD AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-8102
Mailing Address - Country:US
Mailing Address - Phone:703-858-9608
Mailing Address - Fax:703-858-9618
Practice Address - Street 1:19455 DEERFIELD AVE STE 206
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-8102
Practice Address - Country:US
Practice Address - Phone:703-858-9608
Practice Address - Fax:703-858-9618
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101257751207RS0012X, 207RP1001X
TN37872208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3889642Medicare ID - Type UnspecifiedCIGNA MEDICARE
TN3889643Medicare ID - Type Unspecified
H95030Medicare UPIN