Healthcare Provider Details

I. General information

NPI: 1205369691
Provider Name (Legal Business Name): NAMISHA KAUR DHILLON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2017
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8260 WILLOW OAKS CORPORATE DR STE 560
FAIRFAX VA
22031-4515
US

IV. Provider business mailing address

15005 SHADY GROVE RD STE 120
ROCKVILLE MD
20850-6341
US

V. Phone/Fax

Practice location:
  • Phone: 571-350-8434
  • Fax:
Mailing address:
  • Phone: 301-251-8611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number0101282428
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036157529
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberD0100205
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: