Provider Demographics
NPI:1922058668
Name:CHILDREN'S HEART INSTITUTE
Entity Type:Organization
Organization Name:CHILDREN'S HEART INSTITUTE
Other - Org Name:CHILDREN'S HEART CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HASAN
Authorized Official - Middle Name:I
Authorized Official - Last Name:ABDALLAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-481-5801
Mailing Address - Street 1:P.O. BOX 10066
Mailing Address - Street 2:
Mailing Address - City:MCLEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102
Mailing Address - Country:US
Mailing Address - Phone:571-612-2600
Mailing Address - Fax:571-266-4096
Practice Address - Street 1:171 ELDEN STREET, STE. 2C4
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170
Practice Address - Country:US
Practice Address - Phone:571-612-2600
Practice Address - Fax:571-266-4096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101058336174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006716512Medicaid
VAF63079Medicare UPIN