Provider Demographics
NPI:1578566931
Name:ORFALY, M TAREK (MD)
Entity Type:Individual
Prefix:
First Name:M TAREK
Middle Name:
Last Name:ORFALY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MOHAMMED
Other - Middle Name:T
Other - Last Name:ORFALY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 17334
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-1334
Mailing Address - Country:US
Mailing Address - Phone:703-443-6717
Mailing Address - Fax:703-443-8643
Practice Address - Street 1:6355 WALKER LN
Practice Address - Street 2:STE 308
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22310-3247
Practice Address - Country:US
Practice Address - Phone:703-313-7700
Practice Address - Fax:703-313-6718
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101234689207YX0905X, 207YX0602X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic Allergy
No207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2384235OtherAETNA
DCP00725458OtherRR MEDICARE
VA1578566931Medicaid
DCP00725458OtherRR MEDICARE