Provider Demographics
NPI:1972640639
Name:MOHAMMADI GHADIKALAE, SEYED ALI (MD)
Entity type:Individual
Prefix:DR
First Name:SEYED
Middle Name:ALI
Last Name:MOHAMMADI GHADIKALAE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ALI
Other - Middle Name:
Other - Last Name:MOHAMMADI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:7666 HENRY KNOX DR
Mailing Address - Street 2:
Mailing Address - City:LORTON
Mailing Address - State:VA
Mailing Address - Zip Code:22079-4715
Mailing Address - Country:US
Mailing Address - Phone:202-270-0387
Mailing Address - Fax:
Practice Address - Street 1:100 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-4017
Practice Address - Country:US
Practice Address - Phone:301-855-1012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00654124207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDS637R715Medicare PIN