Healthcare Provider Details

I. General information

NPI: 1831572379
Provider Name (Legal Business Name): MADIHA AMJED O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2015
Last Update Date: 02/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17233 COLE RD
HAGERSTOWN MD
21740-6981
US

IV. Provider business mailing address

709 PINE ST
HERNDON VA
20170-4604
US

V. Phone/Fax

Practice location:
  • Phone: 240-329-4699
  • Fax: 240-329-4706
Mailing address:
  • Phone: 703-471-7810
  • Fax: 703-471-6549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0618002429
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: