Basic Information
Provider Information
NPI: 1164625562
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DALAL
FirstName: MONICA
MiddleName: DILIP
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 224-D CORNWALL ST. NW SUITE 403
Address2:  
City: LEESBURG
State: VA
PostalCode: 201762704
CountryCode: US
TelephoneNumber: 7037376010
FaxNumber: 5712919786
Practice Location
Address1: 21475 RIDGETOP CIRCLE SUITE 300
Address2:  
City: STERLING
State: VA
PostalCode: 201668580
CountryCode: US
TelephoneNumber: 7034304400
FaxNumber: 7034304130
Other Information
ProviderEnumerationDate: 06/06/2007
LastUpdateDate: 09/19/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 09/19/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207W00000XMD041384DCN Allopathic & Osteopathic PhysiciansOphthalmology 
207W00000X0101249757VAY Allopathic & Osteopathic PhysiciansOphthalmology 

No ID Information.


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