Basic Information
| Provider Information | |||||||||
| NPI: | 1588606115 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WASHINGTON CARDIOTHORACIC SURGERY ASSOC.,PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 60 | ||||||||
| Address2: | |||||||||
| City: | GERMANTOWN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208750060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3016019600 | ||||||||
| FaxNumber: | 3016013771 | ||||||||
| Practice Location | |||||||||
| Address1: | 2175 K ST NW | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200371831 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2027759375 | ||||||||
| FaxNumber: | 2027751599 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2006 | ||||||||
| LastUpdateDate: | 10/15/2007 | ||||||||
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| AuthorizedOfficialLastName: | GHARAGOZLOO | ||||||||
| AuthorizedOfficialFirstName: | FARID | ||||||||
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| AuthorizedOfficialTitleorPosition: | SENIOR MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 3016019600 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208G00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
ID Information
| ID | Type | State | Issuer | Description | 484AWA | 01 | MD | CARE FIRST BLUE SHIELD | OTHER | J449 | 01 | DC | CAREFIRST BLUESHIELD | OTHER |