Avicenna Medical Clinic, Inc.

Primary specialty

Health Service Clinic/CenterTaxonomy code 261QH0100X

License

0101041949 Issued in VA

Legal business name

AVICENNA MEDICAL CLINIC, INC.

Practice address

50 S Pickett Street
Suite # 221
Alexandria, VA 22304-2922

Phone

(703) 751-7331

Fax

(703) 751-2524

NPI assigned

Aug 20, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Satar Ahmadi, M.D., M.P.H.

Title

Principal

Phone

(703) 751-7331

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156032000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1288742400000",
    "number": "1285749978",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "50 S PICKETT ST",
            "address_2": "SUITE # 221",
            "city": "ALEXANDRIA",
            "state": "VA",
            "postal_code": "223047207",
            "telephone_number": "703-751-7331",
            "fax_number": "703-751-2524"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 S PICKETT STREET",
            "address_2": "SUITE # 221",
            "city": "ALEXANDRIA",
            "state": "VA",
            "postal_code": "223042922",
            "telephone_number": "703-751-7331",
            "fax_number": "703-751-2524"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVICENNA MEDICAL CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-20",
        "last_updated": "2010-11-03",
        "status": "A",
        "authorized_official_last_name": "AHMADI",
        "authorized_official_first_name": "SATAR",
        "authorized_official_title_or_position": "PRINCIPAL",
        "authorized_official_telephone_number": "703-751-7331",
        "authorized_official_credential": "M.D., M.P.H."
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "VA",
            "license": "0101041949",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "005623626",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Health Service Clinic/Center in Alexandria, VA
• Providers in Alexandria, VA by specialty
• Health Service Clinic/Center in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.