Healthcare Provider Details

I. General information

NPI: 1043299472
Provider Name (Legal Business Name): GEORGE W TAWIL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 03/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4660 KENMORE AVE SUITE 735
ALEXANDRIA VA
22304
US

IV. Provider business mailing address

10301 DEMOCRACY LANE SUITE 410
FAIRFAX VA
22030
US

V. Phone/Fax

Practice location:
  • Phone: 703-370-2132
  • Fax: 703-370-8117
Mailing address:
  • Phone: 703-876-5942
  • Fax: 703-876-5972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number33631
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: