Healthcare Provider Details

I. General information

NPI: 1134323884
Provider Name (Legal Business Name): VISHAL MUNGAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 08/11/2023
Certification Date: 08/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3289 WOODBURN RD
ANNANDALE VA
22003-6800
US

IV. Provider business mailing address

3289 WOODBURN RD STE 350
ANNANDALE VA
22003-7357
US

V. Phone/Fax

Practice location:
  • Phone: 703-641-8616
  • Fax: 703-641-9468
Mailing address:
  • Phone: 703-641-8616
  • Fax: 703-641-9468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2011-00523
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberD0084467
License Number StateMD
# 4
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number0101263145
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: