Healthcare Provider Details

I. General information

NPI: 1083139422
Provider Name (Legal Business Name): HIBATULLAH MOHAMMAD KHADER ABU EL-HAIJA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2017
Last Update Date: 09/22/2023
Certification Date: 06/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 MEDICAL CENTER CIR STE 206
FISHERSVILLE VA
22939-2273
US

IV. Provider business mailing address

PO BOX 388
FISHERSVILLE VA
22939-0388
US

V. Phone/Fax

Practice location:
  • Phone: 540-932-5878
  • Fax: 540-332-5876
Mailing address:
  • Phone: 540-932-5162
  • Fax: 540-932-5875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberBP10060887
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberBP20060887
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number0101276446
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: