Basic Information
Provider Information
NPI: 1124317409
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KANDIL
FirstName: ABDURRAHMAN
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 224D CORNWALL ST NW STE 403
Address2:  
City: LEESBURG
State: VA
PostalCode: 201762704
CountryCode: US
TelephoneNumber: 7037376010
FaxNumber:  
Practice Location
Address1: 224-D CORNWALL STREET, NW, SUITE 204,
Address2:  
City: LEESBURG
State: VA
PostalCode: 201762700
CountryCode: US
TelephoneNumber: 7037773262
FaxNumber: 7036652487
Other Information
ProviderEnumerationDate: 04/07/2011
LastUpdateDate: 09/20/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 09/20/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207X00000X0101262687VAY Allopathic & Osteopathic PhysiciansOrthopaedic Surgery 

No ID Information.


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