Healthcare Provider Details

I. General information

NPI: 1548174485
Provider Name (Legal Business Name): HAITHAM BADRAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 TYSONS BLVD STE 100
MC LEAN VA
22102-4880
US

IV. Provider business mailing address

1650 TYSONS BLVD STE 100
MC LEAN VA
22102-4880
US

V. Phone/Fax

Practice location:
  • Phone: 571-596-6793
  • Fax:
Mailing address:
  • Phone: 571-596-6793
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number0101283011
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License Number0101283011
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License Number0101283011
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: