Organization
AHMAD O NOORI MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KEISHA WALLS (BILLING/OFFICE MANAGER)
(703) 742-0061
Entity
Organization
Contact information
Practice address
1860 TOWN CENTER DR, SUITE 280, RESTON, VA 20190-5896
(703) 742-8500
(703) 742-9385
Mailing address
1860 TOWN CENTER DR, SUITE 280, RESTON, VA 20190-5896
(703) 742-8500
(703) 742-9385
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
0101050528
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005826187
—
VA
01
—
336704
ANTHEM
VA
Enumeration date
12/05/2011
Last updated
12/05/2011
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