Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 0101230761 | VA |
NPI | 1013010180 |
---|---|
Provider Name | Ali Jadidi |
First Address | Woodbridge, VA 22191-3908 |
Second Address | Woodbridge, VA 22191-3311 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2006 |
Last Update Date | 08/07/2007 |