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Individual

RAHIB MANSOOR POONAWALA

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
43300 SOUTHERN WALK PLAZA, SUITE 100, BROADLANDS, VA 20148-4463
(571) 252-7353
(571) 223-1797
Mailing address
224 D CORNWALL STREET NW, STE 403, LEESBURG, VA 20176-2704
(703) 737-6010
(703) 443-8643

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101234539
VA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
010275318
VA
05
010275326
VA
05
1578522017
VA
05
30015384640001
VA
Enumeration date
03/22/2006
Last updated
03/19/2024
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