Healthcare Provider Details

I. General information

NPI: 1124211487
Provider Name (Legal Business Name): EDNAN MUSHTAQ MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2007
Last Update Date: 08/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6845 ELM ST SUITE 303
MC LEAN VA
22101-6007
US

IV. Provider business mailing address

6845 ELM ST SUITE 303
MC LEAN VA
22101-6007
US

V. Phone/Fax

Practice location:
  • Phone: 703-448-0005
  • Fax: 703-448-0808
Mailing address:
  • Phone: 703-448-0005
  • Fax: 703-448-0808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number0101055447
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number0101055447
License Number StateVA

VIII. Authorized Official

Name: DR. EDNAN MUSHTAQ
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 703-448-0005