Healthcare Provider Details

I. General information

NPI: 1831320571
Provider Name (Legal Business Name): MOHAMED SULTAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2009
Last Update Date: 09/05/2023
Certification Date: 09/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 EYE STREET NW ROOM 707
WASHINGTON DC
20037
US

IV. Provider business mailing address

3914 CENTREVILLE RD STE 350
CHANTILLY VA
20151-3289
US

V. Phone/Fax

Practice location:
  • Phone: 202-994-4870
  • Fax: 202-994-1604
Mailing address:
  • Phone: 202-994-4870
  • Fax: 202-994-1604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number0101269003
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number86018
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number01080740A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: