Provider Demographics
NPI:1013213875
Name:IKRAM, NADEEM (MEDICAL EQUIPMENT SU)
Entity Type:Individual
Prefix:MR
First Name:NADEEM
Middle Name:
Last Name:IKRAM
Suffix:
Gender:M
Credentials:MEDICAL EQUIPMENT SU
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6910 ELON DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-3730
Mailing Address - Country:US
Mailing Address - Phone:703-825-8989
Mailing Address - Fax:703-879-4618
Practice Address - Street 1:6303 LITTLE RIVER TPKE
Practice Address - Street 2:SUITE NUMBER 335
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22312-5000
Practice Address - Country:US
Practice Address - Phone:703-825-8989
Practice Address - Fax:703-879-4618
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-26
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA9000332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies