Provider Demographics
NPI:1831320571
Name:SULTAN, MOHAMED (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMED
Middle Name:
Last Name:SULTAN
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 1:3914 CENTREVILLE RD
Mailing Address - Street 2:STE 350
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20151-3289
Mailing Address - Country:US
Mailing Address - Phone:202-994-4870
Mailing Address - Fax:202-994-1604
Practice Address - Street 1:2300 EYE STREET NW
Practice Address - Street 2:ROOM 707
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037
Practice Address - Country:US
Practice Address - Phone:202-994-4870
Practice Address - Fax:202-994-1604
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-29
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101269003207RG0100X
SC86018207RG0100X
390200000X
IN01080740A207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty