Basic Information
Provider Information
NPI: 1821205832
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CHEHRAZI
FirstName: ARASH
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2204 WILBORN AVE
Address2:  
City: SOUTH BOSTON
State: VA
PostalCode: 245921645
CountryCode: US
TelephoneNumber: 4345173187
FaxNumber:  
Practice Location
Address1: 2204 WILBORN AVE
Address2:  
City: SOUTH BOSTON
State: VA
PostalCode: 245921645
CountryCode: US
TelephoneNumber: 4345173100
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/17/2007
LastUpdateDate: 05/16/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2085R0202X2008-01342NCN Allopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
2085R0202X0101244676VAY Allopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology

No ID Information.


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