Individual
TAMARA NARIMAN MAMEDOVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
9715 LIBERIA AVE, MANASSAS, VA 20110-5837
(571) 229-1797
(571) 229-1798
Mailing address
5000 COX RD, GLEN ALLEN, VA 23060-9263
(804) 968-5700
(804) 217-7991
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101239490
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010392381
—
VA
Enumeration date
08/13/2006
Last updated
02/17/2022
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