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General NPI Number Information
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NPI Number | 1609040658
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Entity Type | Individual
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Provider Name | IBTEHAL A.SABRI AL-ANI MD
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Gender | Female
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Dates
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Enumeration Date | 04/21/2008
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Last Update Date | 09/24/2013
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Provider Practice Location Address
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Address Line | 1715 WEST THIRD STREET
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City | FARMVILLE
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State | VA
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Zip | 23901-1199
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Country | US
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Telephone | 434-315-0138
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Fax | 434-392-9748
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Provider Business Mailing Address
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Address Line | 1715 WEST THIRD STEET
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City | FARMVILLE
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State | VA
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Zip | 23901
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Country | US
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Telephone | 434-315-0138
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Fax | 434-392-9748
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 0101242689
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License Number State | VA
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