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General NPI Number Information
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NPI Number | 1194804914
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Entity Type | Organization
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Legal Business Name | BARRY B EKDOM PHD, PC
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Dates
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Enumeration Date | 11/03/2006
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Last Update Date | 06/04/2024
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Provider Practice Location Address
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Address Line | 3040 WILLIAMS DR SUITE 402
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City | FAIRFAX
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State | VA
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Zip | 22031-4618
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Country | US
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Telephone | 703-573-3575
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Fax | 703-573-3574
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Provider Business Mailing Address
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Address Line | 3040 WILLIAMS DR SUITE 402
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City | FAIRFAX
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State | VA
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Zip | 22031-4618
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Country | US
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Telephone | 703-573-3575
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Fax | 703-573-3574
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Authorized Official
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Title or Position | OWNER
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Name | DR. NICOLE HASHEMIAN
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Credential | PSYD
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Telephone | 703-573-3573
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 081001775
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License Number State | VA
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