Healthcare Provider Details

I. General information

NPI: 1285612887
Provider Name (Legal Business Name): MOHAMED MARDINI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 10/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8100 ASHTON AVE SUITE 200
MANASSAS VA
20109-5688
US

IV. Provider business mailing address

8100 ASHTON AVE SUITE 200
MANASSAS VA
20109-5688
US

V. Phone/Fax

Practice location:
  • Phone: 703-335-8750
  • Fax:
Mailing address:
  • Phone: 703-331-0300
  • Fax: 703-331-0254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number0101023633
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberD0015898
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: