Individual
DR. ALA SAYED MORTAZAVI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2028 OPITZ BLVD., SUITE B, WOODBRIDGE, VA 22191
(703) 497-0212
(703) 497-0421
Mailing address
313 PARK AVE SUITE 202, FALLS CHURCH, VA 22046-3327
(703) 497-0212
(703) 497-0421
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
0101047023
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005813166
—
VA
01
—
290011028
RAIL ROAD MEDICARE
VA
01
—
290012157
RAIL ROAD MEDICARE
VA
Enumeration date
02/24/2006
Last updated
11/12/2015
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