Provider Demographics
NPI:1588630214
Name:ISKANDER, MEDHAT R (OD)
Entity type:Individual
Prefix:DR
First Name:MEDHAT
Middle Name:R
Last Name:ISKANDER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8614 WESTWOOD CENTER DR FL 9
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2442
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:
Practice Address - Street 1:1197 AIRPORT RD STE 1
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:DE
Practice Address - Zip Code:19963-6418
Practice Address - Country:US
Practice Address - Phone:302-734-5861
Practice Address - Fax:302-734-1921
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001921152W00000X
PAOEG001643152W00000X
DEI3-0001299152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEG00016OtherMEDICARE GROUP PIN
DE11510387OtherCAQH
VA0618001921OtherVA LICENSE
DEI3-0001299OtherDE LICENSE
DE161525705OtherBCBSDE
DE1000038470Medicaid
DE1588630214OtherINDIVIDUAL NPI
DEV06910Medicare UPIN
DE018194H16Medicare ID - Type Unspecified