Healthcare Provider Details

I. General information

NPI: 1740946383
Provider Name (Legal Business Name): FASIKA WALDEAREGAY MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2021
Last Update Date: 11/09/2021
Certification Date: 11/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8316 ARLINGTON BLVD STE 310
FAIRFAX VA
22031-5216
US

IV. Provider business mailing address

8316 ARLINGTON BLVD STE 310
FAIRFAX VA
22031-5216
US

V. Phone/Fax

Practice location:
  • Phone: 703-208-2273
  • Fax:
Mailing address:
  • Phone: 703-208-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: FASIKA WALDEAREGAY
Title or Position: PHYSICIAN OWNER
Credential: MD
Phone: 631-560-3775