Provider Demographics
NPI:1922040278
Name:AL-KADIRI, MOHAMMED (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:
Last Name:AL-KADIRI
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 AVENUE WEST
Mailing Address - Street 2:SUITE A
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180
Mailing Address - Country:US
Mailing Address - Phone:571-407-7004
Mailing Address - Fax:
Practice Address - Street 1:305 MAPLE AVENUE WEST
Practice Address - Street 2:SUITE A
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180
Practice Address - Country:US
Practice Address - Phone:571-407-7004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-098581207P00000X
VA0101241399261QP2300X, 261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036098581Medicaid
IL06032182OtherBLUE CROSS BLUE SHIELD
IL08232205OtherBLUE CROSS BLUE SHIELD
ILP00350409OtherRAILROAD MEDICARE
IL08232204OtherBLUE CROSS BLUE SHIELD
ILK31390Medicare PIN
G87199Medicare UPIN
ILK28953Medicare PIN