Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 0101055447 | VA |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 0101055447 | VA |
NPI | 1639129091 |
---|---|
Provider Name | Ednan Mushtaq |
First Address | Mclean, VA 22101 |
Second Address | Mclean, VA 22101 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2006 |
Last Update Date | 21/08/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F89572 | (02) |