Individual
REZA GOLESORKHI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
12506 LAKE RIDGE DR, C, WOODBRIDGE, VA 22192
(703) 494-6111
(703) 497-0476
Mailing address
12506 LAKE RIDGE DR, WOODBRIDGE, VA 22192
(703) 494-6111
(703) 497-0476
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
B101233727
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5885264
—
VA
Enumeration date
10/16/2006
Last updated
03/24/2009
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