Healthcare Provider Details

I. General information

NPI: 1255409603
Provider Name (Legal Business Name): NABIL FEKRY MALATI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2006
Last Update Date: 11/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43480 YUKON DRIVE SUITE 100
ASHBURN VA
20147-6821
US

IV. Provider business mailing address

2101 EAST JEFFERSON STREET PPQA MEDICARE COMPLIANCE UNIT 6 WEST
ROCKVILLE MD
20852-4908
US

V. Phone/Fax

Practice location:
  • Phone: 571-252-6000
  • Fax: 571-252-6011
Mailing address:
  • Phone: 301-816-6660
  • Fax: 301-816-6308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101047869
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: