Healthcare Provider Details

I. General information

NPI: 1962722157
Provider Name (Legal Business Name): AHMED FIDA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2010
Last Update Date: 08/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 STATION DR
BEALETON VA
22712-9374
US

IV. Provider business mailing address

550 HOSPITAL DR
WARRENTON VA
20186-3027
US

V. Phone/Fax

Practice location:
  • Phone: 540-439-8100
  • Fax: 540-439-8797
Mailing address:
  • Phone: 540-316-5940
  • Fax: 540-316-5941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number27821
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: