Provider Demographics
NPI:1174573356
Name:FOTUHI, MAJID (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:MAJID
Middle Name:
Last Name:FOTUHI
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:MAJID
Other - Middle Name:
Other - Last Name:FOTOUHINIA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:8280 GREENSBORO DR
Mailing Address - Street 2:SUITE 240
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-4905
Mailing Address - Country:US
Mailing Address - Phone:703-462-9296
Mailing Address - Fax:
Practice Address - Street 1:8280 GREENSBORO DR
Practice Address - Street 2:SUITE 240
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22102-4905
Practice Address - Country:US
Practice Address - Phone:703-462-9296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00595072084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDP00157035OtherR/R MEDICARE PROVIDER #
MDC31152OtherR/R MEDICARE GROUP #
MD403075300Medicaid
MDS576G743Medicare PIN
MDP00157035OtherR/R MEDICARE PROVIDER #