Provider Demographics
NPI:1427367721
Name:ADEM, SIRAGE
Entity Type:Individual
Prefix:MR
First Name:SIRAGE
Middle Name:
Last Name:ADEM
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 1:2775 HARTLAND RD STE A
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22043-3529
Mailing Address - Country:US
Mailing Address - Phone:703-629-0968
Mailing Address - Fax:202-330-5971
Practice Address - Street 1:2775 HARTLAND RD STE A
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22043-3529
Practice Address - Country:US
Practice Address - Phone:703-629-0968
Practice Address - Fax:202-330-5971
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-04
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA270519303171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications