Healthcare Provider Details

I. General information

NPI: 1477714202
Provider Name (Legal Business Name): TANIA ALCHALABI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2008
Last Update Date: 10/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 PENNSYLVANIA AVE NW
WASHINGTON DC
20037-3201
US

IV. Provider business mailing address

15425 SHADY GROVE ROAD SUITE 130
ROCKVILLE MD
20850
US

V. Phone/Fax

Practice location:
  • Phone: 202-741-2191
  • Fax:
Mailing address:
  • Phone: 301-527-1650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberD0074668
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberMD03967
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: