Provider Demographics
NPI:1205960630
Name:AL-DALLI, MOHAMMED (MD)
Entity type:Individual
Prefix:DR
First Name:MOHAMMED
Middle Name:
Last Name:AL-DALLI
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 1:1749 OLD MEADOW RD STE 505
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-4325
Mailing Address - Country:US
Mailing Address - Phone:703-356-2800
Mailing Address - Fax:703-356-3407
Practice Address - Street 1:1749 OLD MEADOW RD STE 505
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22102-4325
Practice Address - Country:US
Practice Address - Phone:703-356-2800
Practice Address - Fax:703-356-3407
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101055859207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5814669Medicaid
VAG60201Medicare UPIN
VA5814669Medicaid