Healthcare Provider Details

I. General information

NPI: 1912183682
Provider Name (Legal Business Name): DHIRGHAM KSHASH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2008
Last Update Date: 12/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4010 MAURY PL SUITE 8B
ALEXANDRIA VA
22309-2340
US

IV. Provider business mailing address

4010 MAURY PL SUITE 8B
ALEXANDRIA VA
22309-2340
US

V. Phone/Fax

Practice location:
  • Phone: 703-665-0508
  • Fax:
Mailing address:
  • Phone: 703-665-0508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD0066982
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101249593
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: