Healthcare Provider Details

I. General information

NPI: 1174033229
Provider Name (Legal Business Name): UMME BATOOL HAIDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2017
Last Update Date: 10/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11240 WAPLES MILL RD STE 101
FAIRFAX VA
22030-6078
US

IV. Provider business mailing address

13218 HAWTHORN LN
WOODBRIDGE VA
22193-5107
US

V. Phone/Fax

Practice location:
  • Phone: 703-237-2219
  • Fax: 703-237-2729
Mailing address:
  • Phone: 703-618-2160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: