Healthcare Provider Details

I. General information

NPI: 1194534586
Provider Name (Legal Business Name): AHMAD SOHAIL ABDUL RAHIMZAI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/31/2024
Last Update Date: 12/31/2024
Certification Date: 12/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5533 N MORGAN ST APT 304
ALEXANDRIA VA
22312-5583
US

IV. Provider business mailing address

5533 N MORGAN ST APT 304
ALEXANDRIA VA
22312-5583
US

V. Phone/Fax

Practice location:
  • Phone: 571-550-0176
  • Fax:
Mailing address:
  • Phone: 571-550-0176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number333432453
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: