MEDICARE: DR. MUTAHAR FAUZIA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	0101037011	VA
2	207VE0102X	Reproductive Endocrinology Physician	0101037011	VA
3	207V00000X	Obstetrics & Gynecology Physician	0101037011	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5320010	OTHER	VA	AETNA PPO INS ID
2	1456121	OTHER	VA	UNITED HEALTHCARE ID
3	205757	OTHER	VA	ANTHEM BCBS ID
4	2340766	OTHER	VA	CIGNA INS ID
5	52300001	OTHER	VA	CAREFIRST BCBS ID
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467454223
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MUTAHAR FAUZIA M.D.

Provider Business Mailing Address
First Line	:	5697 COLUMBIA PIKE
Second Line	:	STE 100
City	:	FALLS CHURCH
State	:	VA
Zip	:	22041-2897
Country	:	US
Telephone Number	:	703-845-3400
Fax Number	:	800-485-0703

Provider Business Practice Location Address
First Line	:	5697 COLUMBIA PIKE
Second Line	:	STE 100
City	:	FALLS CHURCH
State	:	VA
Zip	:	22041-2897
Country	:	US
Telephone Number	:	703-845-3400
Fax Number	:	800-485-0703

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	02/21/2013

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