Healthcare Provider Details

I. General information

NPI: 1417341819
Provider Name (Legal Business Name): HADISEH ALIKHANI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2015
Last Update Date: 03/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5999 BURKE COMMONS RD 4TH FLOOR
BURKE VA
22015-2880
US

IV. Provider business mailing address

5999 BURKE COMMONS RD 4TH FLOOR
BURKE VA
22015-2880
US

V. Phone/Fax

Practice location:
  • Phone: 703-249-7922
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number0202212957
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: