MEDICARE: GABRIEL IBRAHIM MOHAMMED JR.

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	247200000X	Other Technician

General Provider Information

NPI Number	:	1952528143
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GABRIEL IBRAHIM MOHAMMED JR.

Provider Business Mailing Address
First Line	:	4200 WILSON BLVD
Second Line	:	SUITE 1100
City	:	ARLINGTON
State	:	VA
Zip	:	22203-1800
Country	:	US
Telephone Number	:	202-493-1224
Fax Number	:	202-493-1218

Provider Business Practice Location Address
First Line	:	4200 WILSON BLVD
Second Line	:	SUITE 1100
City	:	ARLINGTON
State	:	VA
Zip	:	22203-1800
Country	:	US
Telephone Number	:	202-493-1224
Fax Number	:	202-493-1218

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

Provider Enumeration Date	:	04/19/2007
Last Update Date	:	07/08/2007

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