Provider Demographics
NPI:1962572644
Name:MOTAZEDI, ABBAS (MD)
Entity type:Individual
Prefix:
First Name:ABBAS
Middle Name:
Last Name:MOTAZEDI
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:PO BOX 1410
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:VA
Mailing Address - Zip Code:22066
Mailing Address - Country:US
Mailing Address - Phone:202-269-0381
Mailing Address - Fax:202-269-0390
Practice Address - Street 1:1160 VARNUM ST NE
Practice Address - Street 2:111
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017
Practice Address - Country:US
Practice Address - Phone:202-269-0381
Practice Address - Fax:202-269-0390
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC11580207R00000X, 207U00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC011001500Medicaid
DC011001500Medicaid
B95019Medicare UPIN