MEDICARE: DR. MOHEB S ANDRAWIS M.D.

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	208000000X	Pediatrics Physician	0101232408	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689665507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MOHEB S ANDRAWIS M.D.

Provider Business Mailing Address
First Line	:	2500 N VAN DORN ST STE 102
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22302-1601
Country	:	US
Telephone Number	:	703-933-0555
Fax Number	:	703-933-0999

Provider Business Practice Location Address
First Line	:	2500 N VAN DORN ST STE 102
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22302-1601
Country	:	US
Telephone Number	:	703-933-0555
Fax Number	:	703-933-0999

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

Provider Enumeration Date	:	10/31/2005
Last Update Date	:	06/11/2019

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