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General NPI Number Information
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NPI Number | 1407048507
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Entity Type | Organization
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Legal Business Name | MICHAEL MOGADAM, M.D., INC.
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Dates
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Enumeration Date | 08/13/2007
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 4660 KENMORE AVE SUITE #1206
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City | ALEXANDRIA
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State | VA
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Zip | 22304-1313
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Country | US
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Telephone | 703-370-1400
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Fax | 703-370-9742
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Provider Business Mailing Address
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Address Line | 4660 KENMORE AVE SUITE #1206
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City | ALEXANDRIA
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State | VA
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Zip | 22304-1313
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Country | US
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Telephone | 703-370-1400
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Fax | 703-370-9742
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL MOGADAM
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Credential |
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Telephone | 703-370-1400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 0101020264
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License Number State | VA
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