Healthcare Provider Details

I. General information

NPI: 1801191408
Provider Name (Legal Business Name): WISSAM SABRI ZAEETER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2011
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 JOSEPH SIEWICK DR
FAIRFAX VA
22033-1709
US

IV. Provider business mailing address

3221 AMBERLEY LN
FAIRFAX VA
22031-2701
US

V. Phone/Fax

Practice location:
  • Phone: 703-391-3532
  • Fax:
Mailing address:
  • Phone: 201-381-7857
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101269045
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: