Basic Information
| Provider Information | |||||||||
| NPI: | 1609373638 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | MANOOCHEHRI | ||||||||
| FirstName: | OMID | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1468 MADISON AVE | ||||||||
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| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100296508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2128248069 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4320 SEMINARY RD | ||||||||
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| City: | ALEXANDRIA | ||||||||
| State: | VA | ||||||||
| PostalCode: | 223041535 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2406862300 | ||||||||
| FaxNumber: | 2406862330 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2018 | ||||||||
| LastUpdateDate: | 06/17/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/17/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 0101274870 | VA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.