Provider Demographics
NPI:1831309921
Name:MOHARRAM, MANAL (MD)
Entity Type:Individual
Prefix:DR
First Name:MANAL
Middle Name:
Last Name:MOHARRAM
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 1:8905 FARGO RD
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23229-4554
Mailing Address - Country:US
Mailing Address - Phone:804-615-5060
Mailing Address - Fax:804-364-3520
Practice Address - Street 1:8905 FARGO RD
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23229-4554
Practice Address - Country:US
Practice Address - Phone:804-615-5060
Practice Address - Fax:804-364-3520
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301086445208000000X
VA0101248110208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics