Provider Demographics
NPI:1932422326
Name:IRADJ DADGAR-DEHKORDI
Entity Type:Organization
Organization Name:IRADJ DADGAR-DEHKORDI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AZAR
Authorized Official - Middle Name:
Authorized Official - Last Name:DADGAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-403-3322
Mailing Address - Street 1:PO BOX 1625
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20849-1625
Mailing Address - Country:US
Mailing Address - Phone:240-403-3322
Mailing Address - Fax:301-983-4285
Practice Address - Street 1:7801 OLD BRANCH AVE STE 409
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-1644
Practice Address - Country:US
Practice Address - Phone:240-403-3322
Practice Address - Fax:301-983-4285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-12
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0014827284300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD358151900Medicaid
MD358151900Medicaid
MD1790797298Medicare PIN