Healthcare Provider Details

I. General information

NPI: 1689671414
Provider Name (Legal Business Name): ADIL ZAHOOR GHAURI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 08/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3620 JOSEPH SIEWICK DR 306
FAIRFAX VA
22033-1756
US

IV. Provider business mailing address

PO BOX 1019
STUART VA
24171-1019
US

V. Phone/Fax

Practice location:
  • Phone: 703-264-0521
  • Fax: 703-860-0229
Mailing address:
  • Phone: 276-694-4466
  • Fax: 276-694-2909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101 237621
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number0101237621
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: