Healthcare Provider Details

I. General information

NPI: 1174365928
Provider Name (Legal Business Name): MOTAZ MAGDY HANNA FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2024
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 MAPLE AVE W
VIENNA VA
22180-5727
US

IV. Provider business mailing address

PO BOX 791775
BALTIMORE MD
21279-1775
US

V. Phone/Fax

Practice location:
  • Phone: 571-363-3539
  • Fax: 571-363-3540
Mailing address:
  • Phone: 571-302-5000
  • Fax: 571-302-5001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024190318
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: