Healthcare Provider Details

I. General information

NPI: 1386660793
Provider Name (Legal Business Name): SAMIA WASEEM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 12/22/2021
Certification Date: 12/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 N BEAUREGARD ST
ALEXANDRIA VA
22311-1723
US

IV. Provider business mailing address

3650 JOSEPH SIEWICK DR STE 205B
FAIRFAX VA
22033-1712
US

V. Phone/Fax

Practice location:
  • Phone: 703-370-0400
  • Fax:
Mailing address:
  • Phone: 703-620-6221
  • Fax: 703-620-6628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101237874
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: