Active NPI
Morad Tavallali, M.D.
- Specialist
- Vienna, VA
National Provider Identifier
1356435515
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 0101049018
- Practice address
- 8245 Boone Blvd
Suite 540
Vienna, VA 22182-3828 - Phone
- (703) 876-9400
- NPI assigned
- Oct 3, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 0101049018 | VA | Primary |
Addresses
Primary practice location
8245 Boone Blvd
Suite 540
Vienna, VA 22182-3828
Mailing address
8245 Boone Blvd
Suite 540
Vienna, VA 22182-3828
Phone (703) 876-9400
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0101049018 | VA | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159833600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1377475200000",
"number": "1356435515",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8245 BOONE BLVD",
"address_2": "SUITE 540",
"city": "VIENNA",
"state": "VA",
"postal_code": "221823828",
"telephone_number": "703-876-9400"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8245 BOONE BLVD",
"address_2": "SUITE 540",
"city": "VIENNA",
"state": "VA",
"postal_code": "221823828",
"telephone_number": "703-876-9400"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TAVALLALI",
"first_name": "MORAD",
"name_prefix": "Mr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-03",
"last_updated": "2013-08-26",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "VA",
"license": "0101049018",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vienna, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.