Healthcare Provider Details

I. General information

NPI: 1528244217
Provider Name (Legal Business Name): SADIA MASOOD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2008
Last Update Date: 09/21/2021
Certification Date: 09/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2812 OLD LEE HWY STE 210B
FAIRFAX VA
22031-4367
US

IV. Provider business mailing address

PO BOX 2285
CENTREVILLE VA
20122-2285
US

V. Phone/Fax

Practice location:
  • Phone: 703-573-0086
  • Fax:
Mailing address:
  • Phone: 301-742-1704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD0067405
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number0101244167
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101244167
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: