MEDICARE: TALAL AHMAD MUNASIFI 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	174400000X	Specialist	0101034055	VA

General Provider Information

NPI Number	:	1730111212
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TALAL AHMAD MUNASIFI M.D.

Provider Business Mailing Address
First Line	:	1635 N GEORGE MASON DR STE 380
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22205-3616
Country	:	US
Telephone Number	:	703-841-0399
Fax Number	:

Provider Business Practice Location Address
First Line	:	1635 N GEORGE MASON DR STE 380
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22205-3616
Country	:	US
Telephone Number	:	703-841-0399
Fax Number	:

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

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	07/08/2007

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