Provider Demographics
NPI:1215772926
Name:KONTZIAS, SAMIRA MORTAZAVI (CNM, WHNP-BC)
Entity type:Individual
Prefix:
First Name:SAMIRA
Middle Name:MORTAZAVI
Last Name:KONTZIAS
Suffix:
Gender:
Credentials:CNM, WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 N VERMONT ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22203-2048
Mailing Address - Country:US
Mailing Address - Phone:703-999-2578
Mailing Address - Fax:
Practice Address - Street 1:8620 WILLOW OAKS CORP DRIVE
Practice Address - Street 2:SUITE 350
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031
Practice Address - Country:US
Practice Address - Phone:703-260-1179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-26
Last Update Date:2025-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA104118811363LW0102X
VACNM09417176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health