Healthcare Provider Details

I. General information

NPI: 1144309519
Provider Name (Legal Business Name): GHADA ABDALLA ELHAJ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2006
Last Update Date: 11/21/2023
Certification Date: 11/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 N PRESTON RD STE C
PROSPER TX
75078-8882
US

IV. Provider business mailing address

5212 DAWES AVE
ALEXANDRIA VA
22311
US

V. Phone/Fax

Practice location:
  • Phone: 469-488-4900
  • Fax: 469-488-4901
Mailing address:
  • Phone: 703-578-6881
  • Fax: 703-379-6563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberU1491
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101236206
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: