Provider Demographics
NPI:1245727791
Name:BUSAILEH, AHMAD Z (MD)
Entity type:Individual
Prefix:
First Name:AHMAD
Middle Name:Z
Last Name:BUSAILEH
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 1:5089 DONOVAN DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-7755
Mailing Address - Country:US
Mailing Address - Phone:919-272-0790
Mailing Address - Fax:
Practice Address - Street 1:2003 MEDICAL PKWY STE 350
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3081
Practice Address - Country:US
Practice Address - Phone:443-481-1091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-20
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101272653207R00000X
MDD0094904207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine