Healthcare Provider Details

I. General information

NPI: 1780480780
Provider Name (Legal Business Name): MOHAMED REZK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2025
Last Update Date: 02/02/2026
Certification Date: 02/02/2026
Deactivation Date: 09/29/2025
Reactivation Date: 02/02/2026

III. Provider practice location address

110 IRVING ST. NW DEPT OF CARDIOLOGY, ADVANCED HEART FA
WASHINGTON DC
20010
US

IV. Provider business mailing address

110 IRVING ST NW 110 IRVING ST NW DEPT OF CARDIOLOGY, ADVANCED HEART FAI
WASHINGTON DC
20010
US

V. Phone/Fax

Practice location:
  • Phone: 202-993-7860
  • Fax:
Mailing address:
  • Phone: 202-877-7777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0001X
TaxonomyAdvanced Heart Failure and Transplant Cardiology Physician
License NumberMTL600211590
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: