Provider Demographics
NPI:1538171046
Name:TAWEEL, FRED F (MD)
Entity type:Individual
Prefix:
First Name:FRED
Middle Name:F
Last Name:TAWEEL
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 1:1850A TOWN CENTER PKWY
Mailing Address - Street 2:SUITE 209
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-5851
Mailing Address - Country:US
Mailing Address - Phone:703-437-5532
Mailing Address - Fax:703-437-7022
Practice Address - Street 1:1850A TOWN CENTER PKWY
Practice Address - Street 2:SUITE 209
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5851
Practice Address - Country:US
Practice Address - Phone:703-437-5532
Practice Address - Fax:703-437-7022
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101046340207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6031439Medicaid
VAE85651Medicare UPIN
DCG01961I03Medicare ID - Type UnspecifiedDC METRO, N. VA AND MD
VA6031439Medicaid