Provider Demographics
NPI:1588953780
Name:ALTAF, ELHAM WAHEEDA (MD)
Entity type:Individual
Prefix:
First Name:ELHAM
Middle Name:WAHEEDA
Last Name:ALTAF
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 1:4208 EVERGREEN LN STE 213
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-3254
Mailing Address - Country:US
Mailing Address - Phone:703-642-7522
Mailing Address - Fax:703-642-7565
Practice Address - Street 1:4208 EVERGREEN LN STE 213
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-3254
Practice Address - Country:US
Practice Address - Phone:703-642-7522
Practice Address - Fax:703-642-7565
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-29
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101262621207V00000X
IL036137373207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology