Provider Demographics
NPI:1902191570
Name:REDHA, WADDAA R (MD)
Entity Type:Individual
Prefix:
First Name:WADDAA
Middle Name:R
Last Name:REDHA
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 1:6029 MADINSON OVERLOOK CT
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22041
Mailing Address - Country:US
Mailing Address - Phone:773-600-7438
Mailing Address - Fax:
Practice Address - Street 1:2120 L ST, NW
Practice Address - Street 2:SUITE 450
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037
Practice Address - Country:US
Practice Address - Phone:202-741-2911
Practice Address - Fax:202-742-2921
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-13
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
DCMD043175207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program