Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | D58647 | MD |
Y | 208600000X | Surgeon | D58647 | MD |
N | 2082S0105X | Plastic Hand Surgeon | D58647 | MD |
NPI | 1871526426 |
---|---|
Provider Name | Dr. Marwan Riad Khalifeh |
First Address | Mc Lean, VA 22102-3860 |
Second Address | Mc Lean, VA 22102-2835 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2006 |
Last Update Date | 04/03/2020 |