Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0202X | Pediatric Cardiologist | 0101023633 | VA |
N | 2080P0202X | Pediatric Cardiologist | D0015898 | MD |
NPI | 1285612887 |
---|---|
Provider Name | Mohamed Mardini |
First Address | Manassas, VA 20109-5688 |
Second Address | Manassas, VA 20109-5688 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2006 |
Last Update Date | 24/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D09657 | (02) |