Individual
DR. MAHTAB BANEJ FOROOZESH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2001 CRYSTAL SPRING AVE SW STE 300, ROANOKE, VA 24014-2465
(540) 985-8505
Mailing address
213 S JEFFERSON ST STE 1006, ROANOKE, VA 24011-1713
(540) 224-5705
(540) 983-1133
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
17959
MS
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
0101-243723
VA
207RP1001X
Pulmonary Disease Physician
Primary
0101-243723
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03755090
—
MS
Enumeration date
06/19/2006
Last updated
03/05/2024
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