Healthcare Provider Details

I. General information

NPI: 1578566931
Provider Name (Legal Business Name): M TAREK ORFALY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MOHAMMED T ORFALY MD

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 04/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6355 WALKER LN STE 308
ALEXANDRIA VA
22310-3247
US

IV. Provider business mailing address

PO BOX 17334
BALTIMORE MD
21297-1334
US

V. Phone/Fax

Practice location:
  • Phone: 703-313-7700
  • Fax: 703-313-6718
Mailing address:
  • Phone: 703-443-6717
  • Fax: 703-443-8643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number0101234689
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License Number0101234689
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: