Provider Demographics
NPI:1316443385
Name:AL-DAHWAH, KHADIJAH MOHAMMED (MD)
Entity type:Individual
Prefix:DR
First Name:KHADIJAH
Middle Name:MOHAMMED
Last Name:AL-DAHWAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 LOUISA AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-4669
Mailing Address - Country:US
Mailing Address - Phone:757-668-4840
Mailing Address - Fax:757-668-4838
Practice Address - Street 1:324 LOUISA AVE STE 110
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-4669
Practice Address - Country:US
Practice Address - Phone:757-668-4840
Practice Address - Fax:757-668-4838
Is Sole Proprietor?:No
Enumeration Date:2018-03-30
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301505150208000000X
390200000X
VA010272327208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1316443385Medicaid