Provider Demographics
NPI:1881644458
Name:EL MAWAN, MOHAMED H (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMED
Middle Name:H
Last Name:EL MAWAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9755 THORN BUSH DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX STATION
Mailing Address - State:VA
Mailing Address - Zip Code:22039-2540
Mailing Address - Country:US
Mailing Address - Phone:703-492-7771
Mailing Address - Fax:703-492-4442
Practice Address - Street 1:14904 JEFFERSON DAVIS HWY #204
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:20109
Practice Address - Country:US
Practice Address - Phone:703-492-7771
Practice Address - Fax:703-492-4442
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2013-08-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101058502207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005643937Medicaid
VA005643937Medicaid
VA080007303Medicare PIN