Provider Demographics
NPI:1295773679
Name:TAHERI, HAMID (MD)
Entity type:Individual
Prefix:DR
First Name:HAMID
Middle Name:
Last Name:TAHERI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8100 ASHTON AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20109-5622
Mailing Address - Country:US
Mailing Address - Phone:703-331-0300
Mailing Address - Fax:703-331-0254
Practice Address - Street 1:8100 ASHTON AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-5622
Practice Address - Country:US
Practice Address - Phone:703-335-8750
Practice Address - Fax:703-331-0254
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA101052820207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VI10389795OtherCAQH NUMBER
VA204262266OtherTAX ID WARRENTON HEART
VA2500136OtherUNITED HEALTHCARE
VA2501051OtherUNITED HEALTHCARE
VA317184OtherANTHEM PROVIDER NUMBER
VAC08583OtherMEDICARE ID GROUP MANASSAS HEART
VA541984220OtherTAX ID FOR VIRGINIA CARDI
VA70670001OtherCAREFIRST PROVIDER NUMBER
VAC06380OtherPALMETTO MEDICARE GROUP PTAN
DC00A988V73OtherNOVITAS MEDICARE INDIVIDUAL PTAN
VA505405OtherNCPPO PROVIDER NUMBER
VA7602707Medicaid
VA060001022OtherPALMETTO MEDICARE OF VIRGINIA INDIVDUAL PTAN
VA481440OtherOPT/MAMSI/MDIPA NUMBER
VA7135122OtherAETNA PPO PROVIDER NUMBER
VA154789OtherSOUTHERN HEALTH NUMBER
VAC09878OtherMEDICARE ID GROUP WARRENTON HEART
DCG00773OtherNOVITAS MEDICARE GROUP PTAN
VA2337135OtherAETNA HMO PROVIDER NUMBER
VA562289471OtherTAX ID FOR MANASSAS HEART
VA7638574OtherCIGNA HMO PROVIDER NUMBER
VA70670001OtherCAREFIRST PROVIDER NUMBER