Healthcare Provider Details

I. General information

NPI: 1003000126
Provider Name (Legal Business Name): ARDALAN ENKESHAFI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2007
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6410 ROCKLEDGE DR STE 304
BETHESDA MD
20817-1841
US

IV. Provider business mailing address

6410 ROCKLEDGE DR STE 304
BETHESDA MD
20817-1841
US

V. Phone/Fax

Practice location:
  • Phone: 443-602-6207
  • Fax:
Mailing address:
  • Phone: 443-602-6207
  • Fax: 540-224-5684

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD0000290
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD0068455
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101254037
License Number StateVA
# 4
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD600003480
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: