MEDICARE: MOHAMED MARDINI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080P0202X	Pediatric Cardiology Physician	0101023633	VA
2	2080P0202X	Pediatric Cardiology Physician	D0015898	MD

General Provider Information

NPI Number	:	1285612887
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOHAMED MARDINI MD

Provider Business Mailing Address
First Line	:	8100 ASHTON AVE
Second Line	:	SUITE 200
City	:	MANASSAS
State	:	VA
Zip	:	20109-5688
Country	:	US
Telephone Number	:	703-331-0300
Fax Number	:	703-331-0254

Provider Business Practice Location Address
First Line	:	8100 ASHTON AVE
Second Line	:	SUITE 200
City	:	MANASSAS
State	:	VA
Zip	:	20109-5688
Country	:	US
Telephone Number	:	703-335-8750
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2006
Last Update Date	:	10/24/2007

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