Provider Demographics
NPI:1861382970
Name:BOUSRAIH, CHARBEL
Entity type:Individual
Prefix:
First Name:CHARBEL
Middle Name:
Last Name:BOUSRAIH
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 1:11792 INDIAN RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191-3527
Mailing Address - Country:US
Mailing Address - Phone:857-600-6766
Mailing Address - Fax:
Practice Address - Street 1:11792 INDIAN RIDGE RD
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-3527
Practice Address - Country:US
Practice Address - Phone:857-600-6766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-09
Last Update Date:2025-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter