Provider Demographics
NPI:1730162967
Name:EBADI-TEHRANI, MEHRDAD (MD)
Entity type:Individual
Prefix:
First Name:MEHRDAD
Middle Name:
Last Name:EBADI-TEHRANI
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 1:5226 DAWES AVE
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22311-1404
Mailing Address - Country:US
Mailing Address - Phone:703-379-9111
Mailing Address - Fax:703-931-7952
Practice Address - Street 1:5226 DAWES AVE
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22311-1404
Practice Address - Country:US
Practice Address - Phone:703-379-9111
Practice Address - Fax:703-931-7952
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101053922207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0005OtherBS DC
216687OtherBS VA
271769OtherALLIANCE
281214OtherAMERIGROUP
37380005OtherCAPITAL CARE
3738OtherBS DC GROUP
271769OtherMDJPA
2220548OtherUS HEALTH CARE
G76437Medicare UPIN
216687OtherBS VA
0005OtherBS DC