Healthcare Provider Details

I. General information

NPI: 1316142227
Provider Name (Legal Business Name): MANA OGHOLIKHAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8401 CONNECTICUT AVE STE 210
CHEVY CHASE MD
20815-5837
US

IV. Provider business mailing address

4000 MASSACHUSETTS AVE NW APT 1313
WASHINGTON DC
20016-5133
US

V. Phone/Fax

Practice location:
  • Phone: 240-482-2555
  • Fax:
Mailing address:
  • Phone: 202-276-8403
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberD0066213
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: