Provider Demographics
NPI:1053567719
Name:KAVEH PARVARESH, M.D., P.C.
Entity type:Organization
Organization Name:KAVEH PARVARESH, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KAVEH
Authorized Official - Middle Name:
Authorized Official - Last Name:PARVARESH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-671-8444
Mailing Address - Street 1:PO BOX 11149
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22312-0149
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:611 S CARLIN SPRINGS RD STE 309
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22204-1086
Practice Address - Country:US
Practice Address - Phone:703-671-8444
Practice Address - Fax:703-671-2476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-13
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101238365207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010402913Medicaid
VA010402913Medicaid