MEDICARE: DR. MOHAMMED AL-DALLI 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	207R00000X	Internal Medicine Physician	0101055859	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	:	1205960630
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MOHAMMED AL-DALLI M.D.

Provider Business Mailing Address
First Line	:	1749 OLD MEADOW RD STE 505
Second Line	:
City	:	MC LEAN
State	:	VA
Zip	:	22102-4325
Country	:	US
Telephone Number	:	703-356-2800
Fax Number	:	703-356-3407

Provider Business Practice Location Address
First Line	:	1749 OLD MEADOW RD STE 505
Second Line	:
City	:	MC LEAN
State	:	VA
Zip	:	22102-4325
Country	:	US
Telephone Number	:	703-356-2800
Fax Number	:	703-356-3407

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

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	07/01/2021

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