Healthcare Provider Details

I. General information

NPI: 1134964943
Provider Name (Legal Business Name): MOHAMED ELASHAAL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2024
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1141 ELDEN ST FL 3
HERNDON VA
20170-5549
US

IV. Provider business mailing address

151 TREMONT ST APT 11D
BOSTON MA
02111-1110
US

V. Phone/Fax

Practice location:
  • Phone: 703-443-2000
  • Fax:
Mailing address:
  • Phone: 703-909-3771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0401419806
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: