Provider Demographics
NPI:1861467011
Name:HAM, TIBOR JOHN JR (MD)
Entity Type:Individual
Prefix:DR
First Name:TIBOR
Middle Name:JOHN
Last Name:HAM
Suffix:JR
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 1:135 CENTER ST S
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-5720
Mailing Address - Country:US
Mailing Address - Phone:703-938-7800
Mailing Address - Fax:703-938-4541
Practice Address - Street 1:135 CENTER ST S
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-5720
Practice Address - Country:US
Practice Address - Phone:703-938-7800
Practice Address - Fax:703-938-4541
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101027751207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C62091Medicare UPIN