Healthcare Provider Details

I. General information

NPI: 1710160205
Provider Name (Legal Business Name): M KARIM ALI MD FACS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2007
Last Update Date: 12/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1830 TOWN CENTER DR SUITE 209
RESTON VA
20190-3236
US

IV. Provider business mailing address

1830 TOWN CENTER DR SUITE 209
RESTON VA
20190-3236
US

V. Phone/Fax

Practice location:
  • Phone: 703-481-1145
  • Fax: 703-481-1149
Mailing address:
  • Phone: 703-481-1145
  • Fax: 703-481-1149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number0101044267
License Number StateVA

VIII. Authorized Official

Name: ROYA ALI
Title or Position: OFFICE MANAGER
Credential:
Phone: 703-481-1145