Healthcare Provider Details

I. General information

NPI: 1083980494
Provider Name (Legal Business Name): WASEEM UR REHMAN USMANI CSA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2012
Last Update Date: 03/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 JOSEPH SIEWICK DR FAIR OAKS HOSPITAL
FAIRFAX VA
22033-1709
US

IV. Provider business mailing address

8536 BARRINGTON CT
SPRINGFIELD VA
22152-1003
US

V. Phone/Fax

Practice location:
  • Phone: 703-391-3600
  • Fax:
Mailing address:
  • Phone: 703-249-2129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: