Healthcare Provider Details

I. General information

NPI: 1104086693
Provider Name (Legal Business Name): KIRAN IQBAL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2008
Last Update Date: 01/18/2020
Certification Date: 01/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44095 PIPELINE PLZ STE 240
ASHBURN VA
20147-7515
US

IV. Provider business mailing address

44095 PIPELINE PLZ STE 240
ASHBURN VA
20147-7515
US

V. Phone/Fax

Practice location:
  • Phone: 703-723-2999
  • Fax: 703-723-4144
Mailing address:
  • Phone: 703-723-2999
  • Fax: 703-723-4144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberD0070647
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: