Provider Demographics
NPI:1689665507
Name:ANDRAWIS, MOHEB S (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHEB
Middle Name:S
Last Name:ANDRAWIS
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 1:2500 N VAN DORN ST STE 102
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22302-1601
Mailing Address - Country:US
Mailing Address - Phone:703-933-0555
Mailing Address - Fax:703-933-0999
Practice Address - Street 1:2500 N VAN DORN ST STE 102
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22302-1601
Practice Address - Country:US
Practice Address - Phone:703-933-0555
Practice Address - Fax:703-933-0999
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-31
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101232408208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010158435Medicaid
VA010158435Medicaid
VA011983F16Medicare ID - Type Unspecified