Provider Demographics
NPI:1215963517
Name:ROSTAMI, SOHEILA (MD)
Entity type:Individual
Prefix:
First Name:SOHEILA
Middle Name:
Last Name:ROSTAMI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1860 TOWN CENTER DR
Mailing Address - Street 2:SUITE 250
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-5896
Mailing Address - Country:US
Mailing Address - Phone:571-203-1300
Mailing Address - Fax:215-243-7546
Practice Address - Street 1:1860 TOWN CENTER DR
Practice Address - Street 2:SUITE 250
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5896
Practice Address - Country:US
Practice Address - Phone:571-203-1300
Practice Address - Fax:215-243-7546
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-25
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAG86457Medicare UPIN
VAG02132Medicare PIN