Provider Demographics
NPI:1053349498
Name:HADDAD-MASHAD, AFSANE (MD)
Entity type:Individual
Prefix:
First Name:AFSANE
Middle Name:
Last Name:HADDAD-MASHAD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6801 WHITTIER AVE
Mailing Address - Street 2:STE 205
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-4534
Mailing Address - Country:US
Mailing Address - Phone:703-591-1688
Mailing Address - Fax:703-591-1445
Practice Address - Street 1:6801 WHITTIER AVE
Practice Address - Street 2:STE 205
Practice Address - City:MCLEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-4534
Practice Address - Country:US
Practice Address - Phone:703-827-8688
Practice Address - Fax:703-827-8344
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101052422207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0060657240Medicaid
725954Medicare PIN
G08670Medicare UPIN