Mahtab Mollajafar

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0110007682 Issued in VA

Practice address

8212 Roseland Dr
Fairfax Station, VA 22039-2534

Phone

(703) 507-9266

NPI assigned

Feb 3, 2019

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in DC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Privia Medical Group, LLC

  • Internal Medicine Physician
  • Arlington, VA
  • NPI 1013042480

  DC

  Medicare reassignment NPD
• Privia Medical Group, LLC

  • Pain Medicine (Psychiatry & Neurology) Physician
  • Rockville, MD
  • NPI 1811715436
  NPD

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

{
    "created_epoch": "1549152000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634169600000",
    "number": "1659836799",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8212 ROSELAND DR",
            "city": "FAIRFAX STATION",
            "state": "VA",
            "postal_code": "220392534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8212 ROSELAND DR",
            "city": "FAIRFAX STATION",
            "state": "VA",
            "postal_code": "220392534",
            "telephone_number": "703-507-9266"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOLLAJAFAR",
        "first_name": "MAHTAB",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-02-03",
        "last_updated": "2021-10-14",
        "certification_date": "2021-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VA",
            "license": "0110007682",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelly Manya, LCSW
• Jonathan S Maurer, LPC
• Jennifer McMenamin
• Martha R. Miller, LCSW
• Michael Jay Milner, R.PH., J.D.
• Amber Rose Morris, PSYD
• Natural Integrative Healthcare
• New Flower LLC
• Elizabeth-Jane Mengwi Ngongbo, MSN-FNP
• Nam Nguyen, RPH

• Physician Assistant in Fairfax Station, VA
• Providers in Fairfax Station, VA by specialty
• Physician Assistant in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2021; 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.

Verify at the official NPI Registry.