MEDICARE: DR. MONA THERESA ISKANDER 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	208000000X	Pediatrics Physician	D0073374	MD
2	208000000X	Pediatrics Physician	MDD038197	DC
3	208000000X	Pediatrics Physician	ME93244	FL
4	208000000X	Pediatrics Physician	0101239757	VA

General Provider Information

NPI Number	:	1104817535
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MONA THERESA ISKANDER M.D.

Provider Business Mailing Address
First Line	:	8904 GARDEN GATE DR
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22031-1471
Country	:	US
Telephone Number	:	352-359-2725
Fax Number	:

Provider Business Practice Location Address
First Line	:	12255 FAIR LAKES PKWY
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22033-3952
Country	:	US
Telephone Number	:	703-934-5804
Fax Number	:

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

Provider Enumeration Date	:	11/03/2005
Last Update Date	:	05/31/2021

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Directions to “ DR. MONA THERESA ISKANDER M.D.” Practice Location

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