Provider Demographics
NPI:1700080520
Name:GHAZAL, TALAL M (MD)
Entity Type:Individual
Prefix:DR
First Name:TALAL
Middle Name:M
Last Name:GHAZAL
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 1:1635 N GEORGE MASON DR STE 150
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22205-3679
Mailing Address - Country:US
Mailing Address - Phone:571-732-0044
Mailing Address - Fax:866-850-1049
Practice Address - Street 1:1635 N GEORGE MASON DR STE 150
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22205-3679
Practice Address - Country:US
Practice Address - Phone:571-732-0044
Practice Address - Fax:866-850-1049
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101242315207L00000X, 207LP2900X, 208VP0014X
MDD69687207L00000X
MDD0069687208VP0014X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA016303F81OtherMEDICARE
VA1700080520Medicaid
VAK142-001OtherCAREFIRST
DC003324F89OtherMEDICARE