Healthcare Provider Details

I. General information

NPI: 1790564979
Provider Name (Legal Business Name): HSMD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2023
Last Update Date: 09/26/2023
Certification Date: 09/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42488 ROUGH ROCK CT
CHANTILLY VA
20152-3491
US

IV. Provider business mailing address

42488 ROUGH ROCK CT
CHANTILLY VA
20152-3491
US

V. Phone/Fax

Practice location:
  • Phone: 703-300-8827
  • Fax:
Mailing address:
  • Phone: 703-300-8827
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. HASHIM STANAZAI
Title or Position: DIRECTOR
Credential: MD
Phone: 703-300-8827