Provider Demographics
NPI:1679535538
Name:TABASSIAN, ALI REZA (MD, PHD)
Entity type:Individual
Prefix:
First Name:ALI
Middle Name:REZA
Last Name:TABASSIAN
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8720 STONY POINT PKWY STE 105
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235-1989
Mailing Address - Country:US
Mailing Address - Phone:804-644-7478
Mailing Address - Fax:804-644-8224
Practice Address - Street 1:8720 STONY POINT PKWY STE 105
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235-1989
Practice Address - Country:US
Practice Address - Phone:804-644-7478
Practice Address - Fax:804-644-8224
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101054624207WX0107X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6307566Medicaid
F88630Medicare UPIN
180000835Medicare PIN