Individual provider Active NPI

Yanal Haddadeen, MD

  • Dermatology Physician
  • Woodbridge, VA
National Provider Identifier
1063238699
Registry record updated Nov 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
1232000861 Issued in VA
Practice address
13663 Office PL Ste 101
Woodbridge, VA 22192-4216
Phone
(571) 776-6187
NPI assigned
Nov 27, 2024
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 27, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X 1232000861 VA Primary

Addresses

Primary practice location

13663 Office PL Ste 101
Woodbridge, VA 22192-4216

Mailing address

13663 Office PL Ste 101
Woodbridge, VA 22192-4216
Phone (571) 776-6187

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
1232000861VAMDDermatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Permaskin Beauty Center Dermatology CurrentSince Dec 1, 2024 Accepting new patients

Locations

13663 Office Pl
Ste 101
Woodbridge, VA 22192
Phone (571) 776-6187

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1732665600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732665600000",
    "number": "1063238699",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13663 OFFICE PL STE 101",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221924216",
            "telephone_number": "571-776-6187"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13663 OFFICE PL STE 101",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221924216",
            "telephone_number": "571-776-6187"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HADDADEEN",
        "first_name": "YANAL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-11-27",
        "last_updated": "2024-11-27",
        "certification_date": "2024-11-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "VA",
            "license": "1232000861",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodbridge, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.