Provider Demographics
NPI:1790201481
Name:MID ATLANTIC PLASTIC SURGEONS LLC
Entity Type:Organization
Organization Name:MID ATLANTIC PLASTIC SURGEONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KHALIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAHIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-208-0783
Mailing Address - Street 1:3301 WOODBURN RD STE 202
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-7301
Mailing Address - Country:US
Mailing Address - Phone:703-208-0783
Mailing Address - Fax:703-208-1004
Practice Address - Street 1:3301 WOODBURN ROAD, SUITE 202
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003
Practice Address - Country:US
Practice Address - Phone:703-208-0783
Practice Address - Fax:703-208-1004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty