Provider Demographics
NPI:1013484799
Name:AVICENNA CLINIC
Entity Type:Organization
Organization Name:AVICENNA CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:
Authorized Official - Last Name:ELEBIARY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-705-9500
Mailing Address - Street 1:5100 LEESBURG PIKE STE 101
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22302-1000
Mailing Address - Country:US
Mailing Address - Phone:703-705-9500
Mailing Address - Fax:703-417-9051
Practice Address - Street 1:5100 LEESBURG PIKE STE 101
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22302-1000
Practice Address - Country:US
Practice Address - Phone:703-705-9500
Practice Address - Fax:703-417-9051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-31
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty