Provider Demographics
NPI:1144630476
Name:DADGAR, SEYED RAZI
Entity type:Individual
Prefix:
First Name:SEYED RAZI
Middle Name:
Last Name:DADGAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2403 RESEARCH BLVD
Mailing Address - Street 2:STE 200
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-6233
Mailing Address - Country:US
Mailing Address - Phone:301-337-6412
Mailing Address - Fax:240-912-4471
Practice Address - Street 1:2403 RESEARCH BLVD
Practice Address - Street 2:STE 200
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-6233
Practice Address - Country:US
Practice Address - Phone:301-337-6412
Practice Address - Fax:240-912-4471
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-08
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12-110246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD12-110OtherSURGICAL ASSISTANT