Provider Demographics
NPI:1932155421
Name:AKRAMI KHASRAGHI, FARDIN (MD)
Entity Type:Individual
Prefix:DR
First Name:FARDIN
Middle Name:
Last Name:AKRAMI KHASRAGHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:FARDIN
Other - Middle Name:
Other - Last Name:KHASRAGHI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2200 OPITZ BLVD STE 235
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-3343
Mailing Address - Country:US
Mailing Address - Phone:703-910-7390
Mailing Address - Fax:571-408-4127
Practice Address - Street 1:2200 OPITZ BLVD STE 235
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-3343
Practice Address - Country:US
Practice Address - Phone:703-910-7390
Practice Address - Fax:571-408-4127
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101237644174400000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
I41556Medicare UPIN
009324D65Medicare PIN
VA19001958Medicare PIN