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General NPI Number Information
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NPI Number | 1083812911
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Entity Type | Individual
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Provider Name | NOMI SHAOOL M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/03/2007
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Last Update Date | 06/25/2010
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Provider Practice Location Address
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Address Line | 9848C MAIN ST
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City | FAIRFAX
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State | VA
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Zip | 22031-3908
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Country | US
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Telephone | 703-273-2188
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Fax | 703-273-6228
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Provider Business Mailing Address
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Address Line | 9848-C MAIN ST
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City | FAIRFAX
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State | VA
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Zip | 22031
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Country | US
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Telephone | 703-200-6937
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Fax | 703-273-6228
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 0101102463
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License Number State | VA
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