Healthcare Provider Details

I. General information

NPI: 1699810036
Provider Name (Legal Business Name): SURAIYA KURESHI HAIDER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. SURAIYA AISHA KURESHI

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 10/06/2022
Certification Date: 10/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2730 PROSPERITY AVE SUITE D
FAIRFAX VA
22031-4329
US

IV. Provider business mailing address

2730 PROSPERITY AVE SUITE D
FAIRFAX VA
22031-4329
US

V. Phone/Fax

Practice location:
  • Phone: 703-226-2290
  • Fax: 703-226-2428
Mailing address:
  • Phone: 703-226-2290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License Number0101254934
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number241417
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number042-0011415
License Number StateVT
# 4
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License NumberMD429368
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License NumberMD038124
License Number StateDC
# 6
Primary TaxonomyN
Taxonomy Code2080S0012X
TaxonomyPediatric Sleep Medicine Physician
License Number0101254934
License Number StateVA
# 7
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number0101254934
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: