Provider Demographics
NPI:1992964621
Name:REZVANI, MASOUD (MD)
Entity type:Individual
Prefix:
First Name:MASOUD
Middle Name:
Last Name:REZVANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1077 PENSIVE LN
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:VA
Mailing Address - Zip Code:22066-1712
Mailing Address - Country:US
Mailing Address - Phone:267-317-6364
Mailing Address - Fax:888-588-0634
Practice Address - Street 1:14904 JEFFERSON DAVIS HWY STE 209
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-3908
Practice Address - Country:US
Practice Address - Phone:703-595-4566
Practice Address - Fax:703-350-4891
Is Sole Proprietor?:No
Enumeration Date:2008-06-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD433181208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery