1154983724 NPI number — MS. NOURAN WALEED MOLLA MBBS

Table of content: MS. NOURAN WALEED MOLLA MBBS (NPI 1154983724)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154983724 NPI number — MS. NOURAN WALEED MOLLA MBBS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOLLA
Provider First Name:
NOURAN
Provider Middle Name:
WALEED
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MBBS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154983724
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/30/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3640 AL SA'ADAH STREET, ALYASMEEN DISTRICT
Provider Second Line Business Mailing Address:
BUILDING NUMBER 13/A
Provider Business Mailing Address City Name:
RIYADH
Provider Business Mailing Address State Name:
RIYADH
Provider Business Mailing Address Postal Code:
13325
Provider Business Mailing Address Country Code:
SA
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3800 RESERVOIR RD NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20007-2113
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-444-2000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/03/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085B0100X , with the licence number:  MTL005324 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 390200000X , with the licence number: MTL005324 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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