Active NPI
Mannul Wahab Muhiuddin Ahmed, MD
- Internal Medicine Physician
- Chantilly, VA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 0101055858
- Practice address
- 13893 Rembrandt Way
Chantilly, VA 20151-3265 - Phone
- (703) 403-0460
- Fax
- (703) 490-7650
- NPI assigned
- Nov 14, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | D0072076 | MD | |
| Internal Medicine Physician | 207R00000X | MD039289 | DC | |
| Internal Medicine Physician | 207R00000X | 0101055858 | VA | Primary |
Addresses
Primary practice location
13893 Rembrandt Way
Chantilly, VA 20151-3265
Mailing address
2101 East Jefferson Street
Ppqa Medicare Compliance Unit 6 West Attn Theresa Brook
Rockville, MD 20852-4908
Phone (301) 816-6660
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| SOAP URL | https://careepiceast.kp.org:14430/Interconnect-prodmam/wcf/epic.community.hie/xcpdrespondinggateways | Health Information Exchange (HIE) |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in DC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD039289 | DC | MD | Internal Medicine Physician |
| D0072076 | MD | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kaiser Foundation Health Plan of the Mid Atlantic States, Inc | Internal Medicine | Current | Accepting new patients |
Locations
2101 E Jefferson St
Ste 4EAST
Rockville, MD 20852
2101 E Jefferson St
#4E
Rockville, MD 20852
2101 E Jefferson St
Unit 6
Rockville, MD 20852
1221 Mercantile Ln
Upper Marlboro, MD 20774
Phone (301) 618-5500
14139 Potomac Mills Rd
Woodbridge, VA 22192
Phone (703) 257-3000
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.
-
- Health Maintenance Organization
- Annapolis, MD
- NPI 1952461816
DC, Internal Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163462400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1622073600000",
"number": "1689746166",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2101 EAST JEFFERSON STREET",
"address_2": "PPQA MEDICARE COMPLIANCE UNIT 6 WEST ATTN THERESA BROOK",
"city": "ROCKVILLE",
"state": "MD",
"postal_code": "208524908",
"telephone_number": "301-816-6660",
"fax_number": "301-816-6308"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13893 REMBRANDT WAY",
"city": "CHANTILLY",
"state": "VA",
"postal_code": "201513265",
"telephone_number": "703-403-0460",
"fax_number": "703-490-7650"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AHMED",
"first_name": "MANNUL WAHAB",
"middle_name": "MUHIUDDIN",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-14",
"last_updated": "2021-05-27",
"certification_date": "2021-05-27",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "MD",
"license": "D0072076",
"primary": false
},
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "DC",
"license": "MD039289",
"primary": false
},
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "VA",
"license": "0101055858",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "SOAP",
"endpointTypeDescription": "SOAP URL",
"endpoint": "https://careepiceast.kp.org:14430/Interconnect-prodmam/wcf/epic.community.hie/xcpdrespondinggateways",
"affiliation": "N",
"endpointDescription": "Carequality",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "C-CDA",
"address_1": "11245 Huron St",
"city": "Westminster",
"state": "CO",
"country_code": "US",
"postal_code": "802342806",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}
Other providers in Chantilly, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.