Individual
MR. MORAD TAVALLALI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
8245 BOONE BLVD, SUITE 540, VIENNA, VA 22182-3828
(703) 876-9400
Mailing address
8245 BOONE BLVD, SUITE 540, VIENNA, VA 22182-3828
(703) 876-9400
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
0101049018
VA
Other
Enumeration date
10/03/2006
Last updated
08/26/2013
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