Provider Demographics
NPI:1730111212
Name:MUNASIFI, TALAL AHMAD (MD)
Entity Type:Individual
Prefix:
First Name:TALAL
Middle Name:AHMAD
Last Name:MUNASIFI
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 1:1635 N GEORGE MASON DR STE 380
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22205-3616
Mailing Address - Country:US
Mailing Address - Phone:703-841-0399
Mailing Address - Fax:
Practice Address - Street 1:1635 N GEORGE MASON DR STE 380
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22205-3616
Practice Address - Country:US
Practice Address - Phone:703-841-0399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101034055174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC62685Medicare UPIN
VA020005916Medicare ID - Type Unspecified