Individual
DR. JEMAL OMIDVAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5130 DUKE ST, SUITE 7, ALEXANDRIA, VA 22304-2924
(202) 552-9683
(703) 751-2071
Mailing address
5130 DUKE ST, SUITE 7, ALEXANDRIA, VA 22304-2924
(202) 552-9683
(703) 751-2071
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
0101236440
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010125561
—
VA
Enumeration date
05/10/2006
Last updated
07/30/2013
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