Provider Demographics
NPI:1699811026
Name:BEDRI, MAZEN I (MD)
Entity type:Individual
Prefix:
First Name:MAZEN
Middle Name:I
Last Name:BEDRI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 N GEORGE MASON DR
Mailing Address - Street 2:SUITE 324
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22205-3683
Mailing Address - Country:US
Mailing Address - Phone:703-717-4655
Mailing Address - Fax:
Practice Address - Street 1:1625 N GEORGE MASON DR
Practice Address - Street 2:SUITE 324
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22205-3683
Practice Address - Country:US
Practice Address - Phone:703-717-4655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101249226208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery