Provider Demographics
NPI:1902122476
Name:MILLWATER, MEHRNAZ MOMENIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MEHRNAZ
Middle Name:MOMENIAN
Last Name:MILLWATER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MEHRNAZ
Other - Middle Name:
Other - Last Name:HAJI-MOMENIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4911 TILDEN ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016-2331
Mailing Address - Country:US
Mailing Address - Phone:703-593-2301
Mailing Address - Fax:
Practice Address - Street 1:110 IRVING ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-3017
Practice Address - Country:US
Practice Address - Phone:202-877-7227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-08
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD041592207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine