MEDICARE: AMMAR MEDICAL CENTER. LLC

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	261Q00000X	Clinic/Center	0101242663	VA

General Provider Information

NPI Number	:	1336324870
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMMAR MEDICAL CENTER. LLC

Provider Business Mailing Address
First Line	:	14231 OAKPOINTE DR
Second Line	:
City	:	LAUREL
State	:	MD
Zip	:	20707-5865
Country	:	US
Telephone Number	:	410-662-1535
Fax Number	:

Provider Business Practice Location Address
First Line	:	4040 N FAIRFAX DR
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22203-1811
Country	:	US
Telephone Number	:	703-981-1898
Fax Number	:	703-564-5618

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KHAWAJA ATIF FAROOQ
Credential	:	M.D.
Telephone Number	:	703-981-1898

Provider Enumeration Date	:	01/03/2008
Last Update Date	:	10/16/2008

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