Provider Demographics
NPI:1205926854
Name:ALEMZADEH, AMIR (MD)
Entity type:Individual
Prefix:
First Name:AMIR
Middle Name:
Last Name:ALEMZADEH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2068
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22195-2068
Mailing Address - Country:US
Mailing Address - Phone:703-497-4700
Mailing Address - Fax:703-492-6603
Practice Address - Street 1:12731 MARBLESTONE DR
Practice Address - Street 2:STE 200
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-8334
Practice Address - Country:US
Practice Address - Phone:703-497-4700
Practice Address - Fax:703-492-6603
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101230646207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H34559Medicare UPIN
00V508C75Medicare ID - Type Unspecified