Healthcare Provider Details

I. General information

NPI: 1962123752
Provider Name (Legal Business Name): FATRAA ALIY USMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2022
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8600 OLD GEORGETOWN RD
BETHESDA MD
20814-1422
US

IV. Provider business mailing address

8600 OLD GEORGETOWN RD
BETHESDA MD
20814-1422
US

V. Phone/Fax

Practice location:
  • Phone: 770-256-1821
  • Fax:
Mailing address:
  • Phone: --
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number2022000972
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: