Healthcare Provider Details

I. General information

NPI: 1518373299
Provider Name (Legal Business Name): NADINE HAMMOUD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2014
Last Update Date: 01/16/2024
Certification Date: 03/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 WOODBURN RD STE 309
ANNANDALE VA
22003-7308
US

IV. Provider business mailing address

3301 WOODBURN RD STE 309
ANNANDALE VA
22003-7308
US

V. Phone/Fax

Practice location:
  • Phone: 703-844-0171
  • Fax: 703-641-4675
Mailing address:
  • Phone: 703-479-4379
  • Fax: 703-641-4675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number0116027524
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number0101264836
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: