Provider Demographics
NPI:1376722710
Name:ALSAMMAN, MHD MOUNAF (MD)
Entity Type:Individual
Prefix:
First Name:MHD
Middle Name:MOUNAF
Last Name:ALSAMMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MOUNAF
Other - Middle Name:
Other - Last Name:ALSAMMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 37189
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-3189
Mailing Address - Country:US
Mailing Address - Phone:714-235-6995
Mailing Address - Fax:714-423-5698
Practice Address - Street 1:24801 PINEBROOK RD STE 202
Practice Address - Street 2:
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20152-4113
Practice Address - Country:US
Practice Address - Phone:703-722-2510
Practice Address - Fax:703-722-2511
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-02
Last Update Date:2021-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101268432207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN80023342Medicare PIN