Provider Demographics
NPI:1528100211
Name:NASRULLAH, AHMED (MD)
Entity type:Individual
Prefix:DR
First Name:AHMED
Middle Name:
Last Name:NASRULLAH
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 1:19415 DEERFIELD AVE
Mailing Address - Street 2:STE 106
Mailing Address - City:LANSDOWNE
Mailing Address - State:VA
Mailing Address - Zip Code:20176-8452
Mailing Address - Country:US
Mailing Address - Phone:703-723-9633
Mailing Address - Fax:703-723-9772
Practice Address - Street 1:19415 DEERFIELD AVE
Practice Address - Street 2:STE 106
Practice Address - City:LANSDOWNE
Practice Address - State:VA
Practice Address - Zip Code:20176-8452
Practice Address - Country:US
Practice Address - Phone:703-723-9633
Practice Address - Fax:703-723-9772
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101232401207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006310532Medicaid
DCG01409D01Medicare ID - Type Unspecified
VA006310532Medicaid
VA00V208D09Medicare ID - Type UnspecifiedVIRGINIA MEDICARE