Healthcare Provider Details

I. General information

NPI: 1720280886
Provider Name (Legal Business Name): TARIK NOURELDEEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 04/28/2022
Certification Date: 04/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 PARK HILL DR
FREDERICKSBURG VA
22401-3357
US

IV. Provider business mailing address

101 PARK HILL DR
FREDERICKSBURG VA
22401-3357
US

V. Phone/Fax

Practice location:
  • Phone: 540-371-3010
  • Fax: 540-899-9821
Mailing address:
  • Phone: 540-371-3010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number0101255618
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: