MEDICARE: BASIONY TAHER HAGAR

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	122300000X	Dentist	0401412257	VA

General Provider Information

NPI Number	:	1518123967
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BASIONY TAHER HAGAR

Provider Business Mailing Address
First Line	:	5054 TIBBITT LN
Second Line	:
City	:	BURKE
State	:	VA
Zip	:	22015-1520
Country	:	US
Telephone Number	:	703-981-4694
Fax Number	:

Provider Business Practice Location Address
First Line	:	12699 LEE HWY
Second Line	:
City	:	WASHINGTON
State	:	VA
Zip	:	22747-1931
Country	:	US
Telephone Number	:	540-987-9872
Fax Number	:

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

Provider Enumeration Date	:	08/05/2008
Last Update Date	:	08/05/2008

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