Provider Demographics
NPI:1699793372
Name:HEGAB, AHMED (MD)
Entity type:Individual
Prefix:DR
First Name:AHMED
Middle Name:
Last Name:HEGAB
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 1:3700 JOSEPH SIEWICK DR
Mailing Address - Street 2:SUITE 308
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-1744
Mailing Address - Country:US
Mailing Address - Phone:703-698-8960
Mailing Address - Fax:703-716-8703
Practice Address - Street 1:3028 JAVIER RD STE 500
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4622
Practice Address - Country:US
Practice Address - Phone:703-698-8960
Practice Address - Fax:571-494-5794
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101222258207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
238504OtherANTHEM BCBS
238501OtherANTHEM BCBS
79160019OtherCAREFIRST BCBS
246703OtherANTHEM BCBS
VA5883890Medicaid
302437OtherANTHEM BCBS
VA020189G74Medicare PIN
302437OtherANTHEM BCBS
DC00B453C8 G01048Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER