Healthcare Provider Details

I. General information

NPI: 1790011237
Provider Name (Legal Business Name): EMAN ALHARBI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2009
Last Update Date: 10/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3308 SYDENHAM ST APT 202
FAIRFAX VA
22031-4808
US

IV. Provider business mailing address

3308 SYDENHAM ST APT 202
FAIRFAX VA
22031-4808
US

V. Phone/Fax

Practice location:
  • Phone: 201-647-5481
  • Fax:
Mailing address:
  • Phone: 201-647-5481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0116021670
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: