Individual
DR. KOUROSH DIBADJ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
13135 LEE JACKSON MEMORIAL HWY, 135, FAIRFAX, VA 22033-1907
(703) 961-0488
(703) 961-0480
Mailing address
13135 LEE JACKSON MEMORIAL HWY, 135, FAIRFAX, VA 22033-1907
(703) 961-0488
(703) 961-0480
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
0101241367
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1487716593
—
VA
Enumeration date
12/14/2006
Last updated
08/11/2016
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