MEDICARE: DR. ZEINA N KIBLAWI 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	390200000X	Student in an Organized Health Care Education/Training Program
2	2080N0001X	Neonatal-Perinatal Medicine Physician	0101253629	VA

General Provider Information

NPI Number	:	1386836146
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ZEINA N KIBLAWI M.D.

Provider Business Mailing Address
First Line	:	3529 R ST NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20007-2327
Country	:	US
Telephone Number	:	310-936-8309
Fax Number	:

Provider Business Practice Location Address
First Line	:	3529 R ST NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20007-2327
Country	:	US
Telephone Number	:	310-936-8309
Fax Number	:

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

Provider Enumeration Date	:	08/15/2007
Last Update Date	:	02/10/2017

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