MEDICARE: DR. HODA M HACHICHO M.D.

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	2084N0400X	Neurology Physician	0101232553	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104805290
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HODA M HACHICHO M.D.

Provider Business Mailing Address
First Line	:	8650 SUDLEY RD
Second Line	:	SUITE 300
City	:	MANASSAS
State	:	VA
Zip	:	20110-4419
Country	:	US
Telephone Number	:	703-369-0600
Fax Number	:	703-369-7487

Provider Business Practice Location Address
First Line	:	8650 SUDLEY RD
Second Line	:	SUITE 300
City	:	MANASSAS
State	:	VA
Zip	:	20110-4419
Country	:	US
Telephone Number	:	703-369-0600
Fax Number	:	703-369-7487

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/17/2006
Last Update Date	:	07/20/2010

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