Provider Demographics
NPI:1154791721
Name:JAFARPOUR NEUROPAIN LLC
Entity type:Organization
Organization Name:JAFARPOUR NEUROPAIN LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BEHNAM
Authorized Official - Middle Name:
Authorized Official - Last Name:JAFARPOUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:571-393-3277
Mailing Address - Street 1:9303 CENTER ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-1800
Mailing Address - Country:US
Mailing Address - Phone:571-393-3277
Mailing Address - Fax:
Practice Address - Street 1:9303 CENTER ST
Practice Address - Street 2:SUITE 200
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-1800
Practice Address - Country:US
Practice Address - Phone:571-393-3277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-25
Last Update Date:2015-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012559082084N0400X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty