Provider Demographics
NPI:1811558786
Name:ALKALBANI, MUTAZ (MD)
Entity Type:Individual
Prefix:DR
First Name:MUTAZ
Middle Name:
Last Name:ALKALBANI
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 1:612 FAIRFAX AVE APT A
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23507-2075
Mailing Address - Country:US
Mailing Address - Phone:917-624-7393
Mailing Address - Fax:
Practice Address - Street 1:721 FAIRFAX AVE APT A
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-2007
Practice Address - Country:US
Practice Address - Phone:757-446-7934
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-21
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program