Healthcare Provider Details

I. General information

NPI: 1992168496
Provider Name (Legal Business Name): MOHAMAD TAHA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2016
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9530 COSNER DR STE 200
FREDERICKSBURG VA
22408-7760
US

IV. Provider business mailing address

9530 COSNER DR STE 200
FREDERICKSBURG VA
22408-7760
US

V. Phone/Fax

Practice location:
  • Phone: 540-373-1331
  • Fax:
Mailing address:
  • Phone: 540-373-1331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number0101289363
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number0101289363
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: