Healthcare Provider Details

I. General information

NPI: 1134171218
Provider Name (Legal Business Name): IRFAN IDREES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 12/08/2022
Certification Date: 12/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N MAPLE AVE
PURCELLVILLE VA
20132-6102
US

IV. Provider business mailing address

224-D CORNWALL STREET, NW, SUITE 403
LEESBURG VA
20176-2704
US

V. Phone/Fax

Practice location:
  • Phone: 540-338-0177
  • Fax: 540-338-0176
Mailing address:
  • Phone: 703-737-6010
  • Fax: 703-443-8643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101233733
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: