Provider Demographics
NPI:1760506687
Name:ALTAHIR, ALI (MD)
Entity Type:Individual
Prefix:DR
First Name:ALI
Middle Name:
Last Name:ALTAHIR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ALI
Other - Middle Name:
Other - Last Name:AZEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:231 GARRISONVILLE RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-1602
Mailing Address - Country:US
Mailing Address - Phone:703-373-7338
Mailing Address - Fax:703-468-1381
Practice Address - Street 1:231 GARRISONVILLE RD
Practice Address - Street 2:SUITE 205
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-1602
Practice Address - Country:US
Practice Address - Phone:703-373-7338
Practice Address - Fax:703-468-1381
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-17
Last Update Date:2013-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012413852084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry