MEDICARE: RAMI NABIL GHORAB DDS

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	390200000X	Student in an Organized Health Care Education/Training Program
2	1223G0001X	General Practice Dentistry	0401414375	VA

General Provider Information

NPI Number	:	1477895357
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAMI NABIL GHORAB DDS

Provider Business Mailing Address
First Line	:	10635 SUMMER OAK CT
Second Line	:
City	:	BURKE
State	:	VA
Zip	:	22015-2235
Country	:	US
Telephone Number	:	703-975-8713
Fax Number	:

Provider Business Practice Location Address
First Line	:	3650 S GLEBE RD STE 195
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22202-5606
Country	:	US
Telephone Number	:	703-304-3881
Fax Number	:

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

Provider Enumeration Date	:	03/19/2013
Last Update Date	:	03/17/2018

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