Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | 0101048306 | VA |
NPI | 1043230980 |
---|---|
Provider Name | Abdul Wahab |
First Address | Falls Church, VA 22042-2336 |
Second Address | Falls Church, VA 22042-2336 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2006 |
Last Update Date | 15/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5604451 | (05) | VA |
F50940 | (02) |