Healthcare Provider Details

I. General information

NPI: 1639271653
Provider Name (Legal Business Name): TALAL M. NSOULI M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 01/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9520 BURKE RD
BURKE VA
22015-3132
US

IV. Provider business mailing address

9520 BURKE RD
BURKE VA
22015-3132
US

V. Phone/Fax

Practice location:
  • Phone: 703-425-8616
  • Fax: 703-425-8743
Mailing address:
  • Phone: 703-425-8616
  • Fax: 703-425-8743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KI0005X
TaxonomyClinical & Laboratory Immunology (Allergy & Immunology) Physician
License Number010137586
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: