Provider Demographics
NPI:1467448100
Name:KANDAHARI, MASOOM M (MD FACP)
Entity type:Individual
Prefix:MR
First Name:MASOOM
Middle Name:M
Last Name:KANDAHARI
Suffix:
Gender:M
Credentials:MD FACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 WOODSIDE DR
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-1530
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2280 OPITZ BLVD STE 340
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-3362
Practice Address - Country:US
Practice Address - Phone:703-590-8300
Practice Address - Fax:703-590-8301
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101040044207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
21384OtherMAMSI OPT CHOICE ALLIANCE
481116OtherAETNA
VA6098673Medicaid
3600124OtherUNITED HEALTHCARE
143524OtherANTHEM (ARLINGTON)
61950001OtherBC/BS NCA
3722047001OtherCIGNA
P00017437OtherRAILROAD MEDICARE
067857OtherANTHEM (WOODBRIDGE)
C08156Medicare ID - Type Unspecified
C88600Medicare UPIN