Healthcare Provider Details

I. General information

NPI: 1487698965
Provider Name (Legal Business Name): TARIQ M. HADDAD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 12/05/2023
Certification Date: 12/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 TELESTAR CT. #200
FALLS CHURCH VA
22042-1262
US

IV. Provider business mailing address

2901 TELESTAR CT STE 300
FALLS CHURCH VA
22042-1263
US

V. Phone/Fax

Practice location:
  • Phone: 703-573-3494
  • Fax: 703-573-5353
Mailing address:
  • Phone: 703-591-1688
  • Fax: 703-591-1445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number0101241229
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: