Provider Demographics
NPI:1912169202
Name:SEDIGHI, REZA (MD)
Entity type:Individual
Prefix:
First Name:REZA
Middle Name:
Last Name:SEDIGHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MOHAMMAD
Other - Middle Name:REZA
Other - Last Name:SEDIGHI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 2695
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20195-0695
Mailing Address - Country:US
Mailing Address - Phone:703-943-7475
Mailing Address - Fax:
Practice Address - Street 1:1860 TOWN CENTER DR STE 340
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5912
Practice Address - Country:US
Practice Address - Phone:703-943-7475
Practice Address - Fax:866-801-3064
Is Sole Proprietor?:No
Enumeration Date:2008-06-27
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101249708207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine