Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 0101021983 | VA |
NPI | 1194894642 |
---|---|
Provider Name | Dr. Habibollah Ahdoot |
First Address | Alexandria, VA 22310-2110 |
Second Address | Alexandria, VA 22304-1313 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B94640 | (02) | VA |