Provider Demographics
NPI:1376138503
Name:TADROUS, EHAB
Entity Type:Individual
Prefix:
First Name:EHAB
Middle Name:
Last Name:TADROUS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24585 STONE CARVER DR STE 175
Mailing Address - Street 2:
Mailing Address - City:ALDIE
Mailing Address - State:VA
Mailing Address - Zip Code:20105-3255
Mailing Address - Country:US
Mailing Address - Phone:571-367-3914
Mailing Address - Fax:
Practice Address - Street 1:24585 STONE CARVER DR STE 175
Practice Address - Street 2:
Practice Address - City:ALDIE
Practice Address - State:VA
Practice Address - Zip Code:20105-3255
Practice Address - Country:US
Practice Address - Phone:571-367-3914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-09
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202208080183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA12345OtherOWN ID