Provider Demographics
NPI:1487755120
Name:NEMATZADEH, FATEMEH (MD)
Entity type:Individual
Prefix:DR
First Name:FATEMEH
Middle Name:
Last Name:NEMATZADEH
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 1:46179 WESTLAKE DR
Mailing Address - Street 2:STE 250
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20165-5882
Mailing Address - Country:US
Mailing Address - Phone:571-375-2286
Mailing Address - Fax:571-375-2287
Practice Address - Street 1:8550 ARLINGTON BLVD
Practice Address - Street 2:SUITE # 310
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4634
Practice Address - Country:US
Practice Address - Phone:571-375-2286
Practice Address - Fax:571-375-2287
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2016-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012380652084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA258217OtherMEDICARE ID