Provider Demographics
NPI:1912183682
Name:KSHASH, DHIRGHAM (MD)
Entity Type:Individual
Prefix:
First Name:DHIRGHAM
Middle Name:
Last Name:KSHASH
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 1:4010 MAURY PL
Mailing Address - Street 2:SUITE 8B
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22309-2340
Mailing Address - Country:US
Mailing Address - Phone:703-665-0508
Mailing Address - Fax:
Practice Address - Street 1:4010 MAURY PL
Practice Address - Street 2:SUITE 8B
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22309-2340
Practice Address - Country:US
Practice Address - Phone:703-665-0508
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-12
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0066982207R00000X
VA0101249593207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine