Provider Demographics
NPI:1730228263
Name:MOGHAL, FAHEEM NAWAZ (MD)
Entity type:Individual
Prefix:DR
First Name:FAHEEM
Middle Name:NAWAZ
Last Name:MOGHAL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2101 EAST JEFFERSON STREET
Mailing Address - Street 2:KAISER PERMANENTE PPQA 6 WEST
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852
Mailing Address - Country:US
Mailing Address - Phone:301-816-6660
Mailing Address - Fax:301-816-6308
Practice Address - Street 1:1011 NORTH CAPITOL STREET
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002
Practice Address - Country:US
Practice Address - Phone:202-898-5100
Practice Address - Fax:202-898-5470
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2021-12-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA01012380402084P0800X
DCMD0353712084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
016986K92Medicare ID - Type Unspecified
I30897Medicare UPIN