Healthcare Provider Details

I. General information

NPI: 1235844150
Provider Name (Legal Business Name): INNERVE8 MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2023
Last Update Date: 01/30/2024
Certification Date: 01/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2034 EISENHOWER AVE STE 100
ALEXANDRIA VA
22314-5301
US

IV. Provider business mailing address

2034 EISENHOWER AVE STE 100
ALEXANDRIA VA
22314-5301
US

V. Phone/Fax

Practice location:
  • Phone: 703-739-0500
  • Fax: 703-912-0632
Mailing address:
  • Phone: 703-739-0500
  • Fax: 703-912-0632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. WALEED M ABUL-HAWA
Title or Position: OWNER
Credential: DC
Phone: 703-739-0500