Healthcare Provider Details

I. General information

NPI: 1083891659
Provider Name (Legal Business Name): JASPAL AHLUWALIA MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2008
Last Update Date: 08/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

COMDT, USCG HQ (CG-1122), US COAST GUARD STOP 7907 MARTIN LUTHER KING JR AVENUE SE
WASHINGTON DC
20598
US

IV. Provider business mailing address

4200 WILSON BLVD 950
ARLINGTON VA
20598-7198
US

V. Phone/Fax

Practice location:
  • Phone: 703-872-6629
  • Fax:
Mailing address:
  • Phone: 703-872-6629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number01064841A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number01064841A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: