MEDICARE: ANNANDALE PEDIATRIC ASSOC INC

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	41850	VA

General Provider Information

NPI Number	:	1174592745
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANNANDALE PEDIATRIC ASSOC INC

Provider Business Mailing Address
First Line	:	7501 LITTLE RIVER TNPK
Second Line	:	#202
City	:	ANNANDALE
State	:	VA
Zip	:	22003
Country	:	US
Telephone Number	:	703-256-7200
Fax Number	:	703-658-0393

Provider Business Practice Location Address
First Line	:	7501 LITTLE RIVER TNPK
Second Line	:	#202
City	:	ANNANDALE
State	:	VA
Zip	:	22003
Country	:	US
Telephone Number	:	703-256-7200
Fax Number	:	703-658-0393

Authorized Official
Title or Position	:	PRESIDENT
Name	:	AHMAD ELLINI
Credential	:	MD
Telephone Number	:	703-256-7200

Provider Enumeration Date	:	03/16/2006
Last Update Date	:	08/22/2020

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