Provider Demographics
NPI:1548094675
Name:AHMED, MOSTAFA
Entity type:Individual
Prefix:
First Name:MOSTAFA
Middle Name:
Last Name:AHMED
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5703 EDSALL RD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-4711
Mailing Address - Country:US
Mailing Address - Phone:571-722-0357
Mailing Address - Fax:703-997-6539
Practice Address - Street 1:5703 EDSALL RD
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-4711
Practice Address - Country:US
Practice Address - Phone:571-722-0357
Practice Address - Fax:703-997-6539
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-30
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide