Provider Demographics
NPI:1770899361
Name:MAGHZIAN, MOSTAFA
Entity type:Individual
Prefix:MR
First Name:MOSTAFA
Middle Name:
Last Name:MAGHZIAN
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 1:2930 CHAIN BRIDGE RD
Mailing Address - Street 2:SUITE 111
Mailing Address - City:OAKTON
Mailing Address - State:VA
Mailing Address - Zip Code:22124-3041
Mailing Address - Country:US
Mailing Address - Phone:703-319-7972
Mailing Address - Fax:703-319-3903
Practice Address - Street 1:2930 CHAIN BRIDGE RD
Practice Address - Street 2:SUITE 111
Practice Address - City:OAKTON
Practice Address - State:VA
Practice Address - Zip Code:22124
Practice Address - Country:US
Practice Address - Phone:703-319-7972
Practice Address - Fax:703-319-3903
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-20
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1036982332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies