Provider Demographics
NPI:1124065487
Name:MAARIJ INC
Entity type:Organization
Organization Name:MAARIJ INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ISHTIAQ
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-348-7207
Mailing Address - Street 1:1860 TOWN CENTER DR
Mailing Address - Street 2:SUITE 320
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-5896
Mailing Address - Country:US
Mailing Address - Phone:703-348-7207
Mailing Address - Fax:703-435-1844
Practice Address - Street 1:1860 TOWN CENTER DR
Practice Address - Street 2:SUITE 320
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5896
Practice Address - Country:US
Practice Address - Phone:703-348-7207
Practice Address - Fax:703-435-1844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012302452084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010358906Medicaid
VA248660OtherBC/BS OF VA
VA248660OtherBC/BS OF VA
VA010358906Medicaid