Provider Demographics
NPI:1972599272
Name:AHMADZAI, ARIAN (PA)
Entity type:Individual
Prefix:
First Name:ARIAN
Middle Name:
Last Name:AHMADZAI
Suffix:
Gender:
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7503 SURRATTS RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-3358
Mailing Address - Country:US
Mailing Address - Phone:301-870-7001
Mailing Address - Fax:301-870-6697
Practice Address - Street 1:14087 RICHMOND HWY UNIT 101
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-2171
Practice Address - Country:US
Practice Address - Phone:571-300-8000
Practice Address - Fax:571-300-8000
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-22
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0001974363AM0700X
VA0110008984363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD014913S66Medicare ID - Type UnspecifiedINDIVIDUAL MEDICARE #