Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | 0101235832 | VA |
N | 207XS0117X | Orthopaedic Spine Surgeon | D0061155 | MD |
NPI | 1225130966 |
---|---|
Provider Name | Dr. Ali Moshirfar |
First Address | Leesburg, VA 20176-2704 |
Second Address | Leesburg, VA 20176-6821 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2006 |
Last Update Date | 29/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H87815 | (02) | VA |