Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 0401410032 | VA |
N | 1223X0400X | Orthodontists | 056091-1 | NY |
NPI | 1053503151 |
---|---|
Provider Name | Dr. Robert Babak Marzban |
First Address | Mclean, VA 22101 |
Second Address | Mc Lean, VA 22101-3899 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2007 |
Last Update Date | 12/10/2012 |