Provider Demographics
NPI:1790816353
Name:TANNOUS, ANN FAYEZ (MD)
Entity Type:Individual
Prefix:DR
First Name:ANN
Middle Name:FAYEZ
Last Name:TANNOUS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1451 BELLE HAVEN RD STE 110
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22307-1201
Mailing Address - Country:US
Mailing Address - Phone:703-765-6093
Mailing Address - Fax:
Practice Address - Street 1:1451 BELLE HAVEN RD
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22307-1201
Practice Address - Country:US
Practice Address - Phone:703-765-6093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT188350208000000X
DECT70003529208000000X
TXN8997208000000X
VA0101268379208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics