Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 0101254037 | VA |
Y | 111NI0900X | Internist | 0101254037 | VA |
N | 207R00000X | Internist | D0000290 | MD |
N | 111NI0900X | Internist | D0000290 | MD |
N | 207R00000X | Internist | D0068455 | MD |
N | 111NI0900X | Internist | D0068455 | MD |
NPI | 1003000126 |
---|---|
Provider Name | Ardalan Enkeshafi |
First Address | Bethesda, MD 20817-1841 |
Second Address | Bethesda, MD 20817-1841 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2007 |
Last Update Date | 12/02/2021 |