Basic Information
| Provider Information | |||||||||
| NPI: | 1023066362 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DADGAR | ||||||||
| FirstName: | ANUSHIRAVAN | ||||||||
| MiddleName: | |||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10110 MOLECULAR DRIVE | ||||||||
| Address2: | SUITE 206 | ||||||||
| City: | ROCKVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208507542 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3013436505 | ||||||||
| FaxNumber: | 2404030190 | ||||||||
| Practice Location | |||||||||
| Address1: | 10110 MOLECULAR DR | ||||||||
| Address2: | SUITE 206 | ||||||||
| City: | ROCKVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208507539 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3012792779 | ||||||||
| FaxNumber: | 2404030190 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2006 | ||||||||
| LastUpdateDate: | 04/05/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | H0051280 | MD | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 351201100 | 05 | MD | MEDICAID |