Provider Demographics
NPI:1710051859
Name:ZAGHAL, SALEH M
Entity Type:Individual
Prefix:MR
First Name:SALEH
Middle Name:M
Last Name:ZAGHAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:722 GRANT ST
Mailing Address - Street 2:SUITE L
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-4532
Mailing Address - Country:US
Mailing Address - Phone:703-464-9132
Mailing Address - Fax:
Practice Address - Street 1:722 GRANT ST
Practice Address - Street 2:SUITE L
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-4532
Practice Address - Country:US
Practice Address - Phone:703-464-9132
Practice Address - Fax:703-464-9662
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1156930001Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER