Provider Demographics
NPI:1851381701
Name:AL-KHATEEB, DEANA GHASSAN (MD)
Entity Type:Individual
Prefix:DR
First Name:DEANA
Middle Name:GHASSAN
Last Name:AL-KHATEEB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2000 OPITZ BLVD
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-3306
Mailing Address - Country:US
Mailing Address - Phone:703-499-9144
Mailing Address - Fax:703-730-5124
Practice Address - Street 1:2296 OPITZ BLVD
Practice Address - Street 2:STE 330
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-3300
Practice Address - Country:US
Practice Address - Phone:703-670-7600
Practice Address - Fax:703-730-5124
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-24
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101226166207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007150R73Medicare PIN
H23715Medicare UPIN