Basic Information
Provider Information
NPI: 1366819047
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MAHER
FirstName: AHMED
MiddleName: ABDELFATTAH
NamePrefix: DR.
NameSuffix:  
Credential: M.D
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: 5712919786
Practice Location
Address1: 4660 KENMORE AVENUE, SUITES 305 & 500
Address2:  
City: ALEXANDRIA
State: VA
PostalCode: 223041306
CountryCode: US
TelephoneNumber: 7037515763
FaxNumber: 7033708704
Other Information
ProviderEnumerationDate: 08/28/2015
LastUpdateDate: 10/05/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 10/05/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RG0100X0101275087VAY Allopathic & Osteopathic PhysiciansInternal MedicineGastroenterology

No ID Information.


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