MEDICARE: DHIRGHAM KSHASH 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	D0066982	MD
2	207R00000X	Internal Medicine Physician	0101249593	VA

General Provider Information

NPI Number	:	1912183682
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DHIRGHAM KSHASH M.D.

Provider Business Mailing Address
First Line	:	4010 MAURY PL
Second Line	:	SUITE 8B
City	:	ALEXANDRIA
State	:	VA
Zip	:	22309-2340
Country	:	US
Telephone Number	:	703-665-0508
Fax Number	:

Provider Business Practice Location Address
First Line	:	4010 MAURY PL
Second Line	:	SUITE 8B
City	:	ALEXANDRIA
State	:	VA
Zip	:	22309-2340
Country	:	US
Telephone Number	:	703-665-0508
Fax Number	:

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

Provider Enumeration Date	:	01/12/2008
Last Update Date	:	12/23/2013

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