Provider Demographics
NPI:1477541167
Name:ALZEER-KHALIFEH, SIHAM (MD)
Entity Type:Individual
Prefix:
First Name:SIHAM
Middle Name:
Last Name:ALZEER-KHALIFEH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 ELON RD
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:24572-2536
Mailing Address - Country:US
Mailing Address - Phone:434-455-2480
Mailing Address - Fax:434-455-2487
Practice Address - Street 1:554 BLUE RIDGE AVE SUITE 8
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:VA
Practice Address - Zip Code:24523
Practice Address - Country:US
Practice Address - Phone:434-455-2480
Practice Address - Fax:434-455-2487
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101255490208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA228456859AMedicaid
GA228456859AMedicaid
I15307Medicare UPIN
TN3002535Medicare PIN