Provider Demographics
NPI:1790729317
Name:MIRKHEL, AHMADSHAH (MD)
Entity Type:Individual
Prefix:
First Name:AHMADSHAH
Middle Name:
Last Name:MIRKHEL
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 1:13135 LEE JACKSON MEMORIAL HWY
Mailing Address - Street 2:SUITE 135
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-1907
Mailing Address - Country:US
Mailing Address - Phone:703-961-0488
Mailing Address - Fax:703-961-0480
Practice Address - Street 1:13135 LEE JACKSON MEMORIAL HWY
Practice Address - Street 2:#135
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-1907
Practice Address - Country:US
Practice Address - Phone:703-961-0488
Practice Address - Fax:703-961-0480
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101239838207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1790729317Medicaid
VAVV3542BMedicare PIN
DC019968ZD3WMedicare PIN