Provider Demographics
NPI:1639271653
Name:NSOULI, TALAL M (MD)
Entity Type:Individual
Prefix:
First Name:TALAL
Middle Name:M
Last Name:NSOULI
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 1:9520 BURKE RD
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-3132
Mailing Address - Country:US
Mailing Address - Phone:703-425-8616
Mailing Address - Fax:703-425-8743
Practice Address - Street 1:9520 BURKE RD
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015-3132
Practice Address - Country:US
Practice Address - Phone:703-425-8616
Practice Address - Fax:703-425-8743
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA010137586207KI0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KI0005XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyClinical & Laboratory Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA459238Medicare ID - Type Unspecified
B95045Medicare UPIN