Healthcare Provider Details

I. General information

NPI: 1063469393
Provider Name (Legal Business Name): SOHAIL K MIRZA M.D., M.P.H.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 05/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4250 CHAIN BRIDGE RD
FAIRFAX VA
22030-4214
US

IV. Provider business mailing address

4250 CHAIN BRIDGE RD
FAIRFAX VA
22030-4214
US

V. Phone/Fax

Practice location:
  • Phone: 703-828-6579
  • Fax: 571-458-7336
Mailing address:
  • Phone: 703-828-6579
  • Fax: 571-458-7336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number79228
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number14258
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number0101261117
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number79154 8002
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number34710
License Number StateCO
# 6
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberMD00031150
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: