Provider Demographics
NPI:1609867381
Name:ABOU-GHAZALA, TAREK (MD)
Entity Type:Individual
Prefix:DR
First Name:TAREK
Middle Name:
Last Name:ABOU-GHAZALA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12330 PINECREST RD STE 125
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191-1655
Mailing Address - Country:US
Mailing Address - Phone:703-822-5250
Mailing Address - Fax:571-252-5595
Practice Address - Street 1:12330 PINECREST RD STE 125
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-1655
Practice Address - Country:US
Practice Address - Phone:703-822-5250
Practice Address - Fax:571-252-5595
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0059691207RC0000X
VA0101237500207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD016161S66Medicare ID - Type UnspecifiedINDIVIDUAL MEDICARE NO.