Provider Demographics
NPI:1891753406
Name:MAHDI, HANIBAL (MD)
Entity Type:Individual
Prefix:DR
First Name:HANIBAL
Middle Name:
Last Name:MAHDI
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 1:305 MAPLE AVE W STE A
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-4306
Mailing Address - Country:US
Mailing Address - Phone:571-407-7004
Mailing Address - Fax:571-407-7092
Practice Address - Street 1:305 MAPLE AVE W STE A
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-4306
Practice Address - Country:US
Practice Address - Phone:571-407-7004
Practice Address - Fax:571-407-7092
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101056882207P00000X, 207PE0004X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1891753406Medicaid
VAP00023208OtherRAILROAD MEDICARE
VA1891753406Medicaid
VA010031834Medicaid
VA267139OtherBLUE SHIELD
VA5886325Medicaid
VA5886325Medicaid
VA013006N16Medicare PIN
VAP00023208OtherRAILROAD MEDICARE
VA010031834Medicaid
WV1891753406Medicaid
VAMC12514Medicare PIN