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General NPI Number Information
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NPI Number | 1275763617
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Entity Type | Organization
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Legal Business Name | LOUDOUN OPHTHALMOLOGY ASSOCIATES LLC
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Dates
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Enumeration Date | 07/20/2009
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Last Update Date | 11/05/2015
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Provider Practice Location Address
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Address Line | 171 ELDEN ST STE 2C3
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City | HERNDON
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State | VA
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Zip | 20170-4869
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Country | US
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Telephone | 703-751-4040
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Fax | 703-542-4254
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Provider Business Mailing Address
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Address Line | 44125 WOODRIDGE PKWY STE 180
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City | LEESBURG
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State | VA
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Zip | 20176-6839
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Country | US
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Telephone | 571-291-2432
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Fax | 703-542-4254
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Authorized Official
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Title or Position | SOLE OWNER
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Name | DR. ABDELRAHMAN ELBASH
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Credential | M.D.
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Telephone | 703-751-4040
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 0101245181
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License Number State | VA
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