Basic Information
| Provider Information | |||||||||
| NPI: | 1003000126 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ENKESHAFI | ||||||||
| FirstName: | ARDALAN | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6410 ROCKLEDGE DR STE 304 | ||||||||
| Address2: | |||||||||
| City: | BETHESDA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208171841 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4436026207 | ||||||||
| FaxNumber: | 5402245684 | ||||||||
| Practice Location | |||||||||
| Address1: | 6410 ROCKLEDGE DR STE 304 | ||||||||
| Address2: | |||||||||
| City: | BETHESDA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208171841 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4436026207 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2007 | ||||||||
| LastUpdateDate: | 02/12/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | D0000290 | MD | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | D0068455 | MD | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 0101254037 | VA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.