Provider Demographics
NPI:1639432198
Name:AL BAQUI, NOWAL (MD)
Entity Type:Individual
Prefix:DR
First Name:NOWAL
Middle Name:
Last Name:AL BAQUI
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:13135 LEE JACKSON MEM HWY
Mailing Address - Street 2:SUITE 135
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-1907
Mailing Address - Country:US
Mailing Address - Phone:703-961-0484
Mailing Address - Fax:703-961-9103
Practice Address - Street 1:13135 LEE JACKSON MEMORIAL HWY
Practice Address - Street 2:#135
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-1907
Practice Address - Country:US
Practice Address - Phone:703-961-0488
Practice Address - Fax:703-961-0480
Is Sole Proprietor?:No
Enumeration Date:2012-06-20
Last Update Date:2016-08-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101258454207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1639432198Medicaid
VA1639432198Medicaid
VAVVI449AMedicare PIN