Healthcare Provider Details

I. General information

NPI: 1356507990
Provider Name (Legal Business Name): HEBA K ELZAWAHRY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2008
Last Update Date: 11/27/2023
Certification Date: 10/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3570 JOSEPH SIEWICK DR. SUITE 400
HERNDON VA
22033
US

IV. Provider business mailing address

3650 JOSEPH SIEWICK DR STE 400
FAIRFAX VA
22033-1715
US

V. Phone/Fax

Practice location:
  • Phone: 310-392-8636
  • Fax:
Mailing address:
  • Phone: 310-392-8636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01012385
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number131430
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: