Provider Demographics
NPI:1528499209
Name:SHAHVERDI, KHACHATOOR (CSA)
Entity type:Individual
Prefix:
First Name:KHACHATOOR
Middle Name:
Last Name:SHAHVERDI
Suffix:
Gender:M
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 RESEARCH CT
Mailing Address - Street 2:SU 450
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3221
Mailing Address - Country:US
Mailing Address - Phone:240-403-4067
Mailing Address - Fax:301-519-8001
Practice Address - Street 1:1 RESEARCH CT
Practice Address - Street 2:SU 450
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3221
Practice Address - Country:US
Practice Address - Phone:240-403-4067
Practice Address - Fax:301-519-8001
Is Sole Proprietor?:No
Enumeration Date:2013-12-06
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDNSAA 3871174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist