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General NPI Number Information
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NPI Number | 1174979587
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Entity Type | Individual
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Provider Name | TAALIBA AL-ALIM SAHIB JR. AG ACNP
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Gender | Male
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Dates
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Enumeration Date | 05/05/2016
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Last Update Date | 05/21/2024
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Provider Practice Location Address
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Address Line | 721 MCCORMICK FARM DR UNIT B
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City | GLEN ALLEN
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State | VA
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Zip | 23060-4035
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Country | US
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Telephone | 757-214-3998
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Fax |
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Provider Business Mailing Address
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Address Line | 100 HOSPITAL RD
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City | PRINCE FREDERICK
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State | MD
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Zip | 20678-4017
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Country | US
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Telephone | 757-316-5800
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Fax | 757-534-5190
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | AC004504
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 0024175434
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | RN228237
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License Number State | GA
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