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General NPI Number Information
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NPI Number | 1689746166
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Entity Type | Individual
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Provider Name | MANNUL WAHAB MUHIUDDIN AHMED MD
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Gender | Male
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Dates
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Enumeration Date | 11/14/2006
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Last Update Date | 05/27/2021
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Provider Practice Location Address
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Address Line | 13893 REMBRANDT WAY
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City | CHANTILLY
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State | VA
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Zip | 20151-3265
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Country | US
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Telephone | 703-403-0460
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Fax | 703-490-7650
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Provider Business Mailing Address
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Address Line | 2101 EAST JEFFERSON STREET PPQA MEDICARE COMPLIANCE UNIT 6 WEST ATTN THERESA BROOK
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City | ROCKVILLE
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State | MD
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Zip | 20852-4908
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Country | US
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Telephone | 301-816-6660
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Fax | 301-816-6308
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | D0072076
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD039289
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License Number State | DC
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 0101055858
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License Number State | VA
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