Healthcare Provider Details

I. General information

NPI: 1457572349
Provider Name (Legal Business Name): MAHER A HUTTAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 05/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2946 SLEEPY HOLLOW RD STE 2D
FALLS CHURCH VA
22044-2003
US

IV. Provider business mailing address

2946 SLEEPY HOLLOW RD STE 2D
FALLS CHURCH VA
22044-2003
US

V. Phone/Fax

Practice location:
  • Phone: 571-969-4242
  • Fax: 866-866-7719
Mailing address:
  • Phone: 571-969-4242
  • Fax: 866-866-7719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0101241929
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: