Basic Information
| Provider Information | |||||||||
| NPI: | 1700080520 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GHAZAL | ||||||||
| FirstName: | TALAL | ||||||||
| MiddleName: | M. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2730 UNIVERSITY BLVD W | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | WHEATON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 209021905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3019428799 | ||||||||
| FaxNumber: | 3019338554 | ||||||||
| Practice Location | |||||||||
| Address1: | 2730 UNIVERSITY BLVD W | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | WHEATON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 209021905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3019428799 | ||||||||
| FaxNumber: | 3019338554 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2007 | ||||||||
| LastUpdateDate: | 11/01/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 241371 | NY | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 0101242315 | VA | N | Allopathic & Osteopathic Physicians | Anesthesiology | 208VP0014X | 0101242315 | VA | N | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine | 207LP2900X | 0101242315 | VA | N | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 208VP0014X | D0069687 | MD | Y | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine | 207L00000X | D0069687 | MD | N | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 016303F81 | 01 | VA | MEDICARE | OTHER | 1700080520 | 05 | VA | MEDICAID | K142-001 | 01 | VA | CAREFIRST | OTHER | 003324F89 | 01 | DC | MEDICARE | OTHER |