Provider Demographics
NPI:1992964837
Name:AILANI, HARESH (MD)
Entity type:Individual
Prefix:
First Name:HARESH
Middle Name:
Last Name:AILANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8136 OLD KEENE MILL RD STE B300
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22152-1856
Mailing Address - Country:US
Mailing Address - Phone:703-451-6111
Mailing Address - Fax:703-451-6247
Practice Address - Street 1:8136 OLD KEENE MILL RD STE B300
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22152-1856
Practice Address - Country:US
Practice Address - Phone:703-451-6111
Practice Address - Fax:703-451-6247
Is Sole Proprietor?:No
Enumeration Date:2008-06-05
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101245520207WX0120X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0120XAllopathic & Osteopathic PhysiciansOphthalmologyCornea and External Diseases Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA54-1168250OtherTAX ID
VA073059Medicare PIN
VACI3948Medicare PIN
VA157979ZDVVMedicare PIN
VACJ7068Medicare PIN
VA020049E23Medicare PIN
VAC09123Medicare PIN