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General NPI Number Information
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NPI Number | 1427334747
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Entity Type | Individual
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Provider Name | TAYSEER ALDAGHLAS M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/01/2011
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Last Update Date | 02/27/2020
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Provider Practice Location Address
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Address Line | 10701 MAIN ST
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City | FAIRFAX
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State | VA
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Zip | 22030-6904
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Country | US
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Telephone | 703-855-1771
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Fax |
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Provider Business Mailing Address
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Address Line | 2776 S ARLINGTON MILL DR UNIT 505
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City | ARLINGTON
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State | VA
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Zip | 22206-3402
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Country | US
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Telephone |
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Fax |
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 0101249887
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0101249887
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License Number State | VA
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