Healthcare Provider Details

I. General information

NPI: 1376692434
Provider Name (Legal Business Name): SOFIA RIZWAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SOFIA RIZWAN KHURSHID M.D.

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 11/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5999 BURKE COMMONS RD
BURKE VA
22015-2880
US

IV. Provider business mailing address

5999 BURKE COMMONS RD
BURKE VA
22015-2880
US

V. Phone/Fax

Practice location:
  • Phone: 703-249-7200
  • Fax: 703-249-7238
Mailing address:
  • Phone: 703-249-7200
  • Fax: 703-249-7238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD36292
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101238675
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: