Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | 0101053161 | VA |
NPI | 1134207525 |
---|---|
Provider Name | Mohammad Bahadori |
First Address | Woodbridge, VA 22191-3908 |
Second Address | Woodbridge, VA 22191-3908 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B77436 | (02) | VA |