Provider Demographics
NPI:1912929233
Name:GHAFOURI, MOHSEN (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHSEN
Middle Name:
Last Name:GHAFOURI
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 215
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20109-5622
Mailing Address - Country:US
Mailing Address - Phone:703-361-3255
Mailing Address - Fax:703-361-6990
Practice Address - Street 1:8100 ASHTON AVE
Practice Address - Street 2:SUITE 215
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-5622
Practice Address - Country:US
Practice Address - Phone:703-361-3255
Practice Address - Fax:703-361-6990
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101233757207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAH84324Medicare UPIN
C09705Medicare ID - Type Unspecified