Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | D004408 | MD |
NPI | 1356371785 |
---|---|
Provider Name | Dr. Basil Maghak |
First Address | Reston, VA 20190-3219 |
Second Address | Reston, VA 20190-3219 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2006 |
Last Update Date | 04/05/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
234401700 | (05) | MD |
F86298 | (02) | MD |