Individual
MADHAB LAMICHHANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
14605 POTOMAC BRANCH DR STE 210, WOODBRIDGE, VA 22191-3337
(703) 780-9014
(703) 780-9077
Mailing address
PO BOX 37174, BALTIMORE, MD 21297-3174
(571) 423-5699
(571) 423-5698
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
036.123006
IL
207R00000X
Internal Medicine Physician
125050611
IL
207R00000X
Internal Medicine Physician
4301098068
MI
207RA0001X
Advanced Heart Failure and Transplant Cardiology Physician
Primary
0101264702
VA
207RA0001X
Advanced Heart Failure and Transplant Cardiology Physician
67204
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036.123006
STATE OF ILLINOIS DFPR PHYSICIAN LICENSURE
IL
01
—
125-050611
PHYSICIAN TEMPORARY LICEN
IL
05
—
1932302098
—
MI
01
—
4301098068
PHYSICIAN LICENSE, BOARD OF MEDICINE
MI
01
—
809840
MEDICARE GROUP PTAN
IL
Enumeration date
06/07/2007
Last updated
09/26/2022
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