Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0205X | Pediatric Endocrinologist | 0101245162 | VA |
NPI | 1447491824 |
---|---|
Provider Name | Dr. Shadi Tabba |
First Address | Herndon, VA 20170-4875 |
Second Address | Herndon, VA 20170-4875 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2009 |
Last Update Date | 13/03/2014 |