Healthcare Provider Details

I. General information

NPI: 1154983724
Provider Name (Legal Business Name): NOURAN WALEED MOLLA MBBS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2019
Last Update Date: 06/30/2020
Certification Date: 06/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 RESERVOIR RD NW
WASHINGTON DC
20007-2113
US

IV. Provider business mailing address

3640 AL SA'ADAH STREET, ALYASMEEN DISTRICT BUILDING NUMBER 13/A
RIYADH RIYADH
13325
SA

V. Phone/Fax

Practice location:
  • Phone: 202-444-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License NumberMTL005324
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberMTL005324
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: