MEDICARE: GORGE WASHINGTON UNIVERSITY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1033556600
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GORGE WASHINGTON UNIVERSITY

Provider Business Mailing Address
First Line	:	4744 OAK ST
Second Line	:	APT 940
City	:	KANSAS CITY
State	:	MO
Zip	:	64112-2269
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4744 OAK ST
Second Line	:	APT 940
City	:	KANSAS CITY
State	:	MO
Zip	:	64112-2269
Country	:	US
Telephone Number	:	312-560-1499
Fax Number	:

Authorized Official
Title or Position	:	NEUROLOGY RESIDENT PGY2
Name	:	EALAF AHMED ALRABIA
Credential	:	M.D
Telephone Number	:	312-560-1499

Provider Enumeration Date	:	05/22/2013
Last Update Date	:	05/22/2013

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