Healthcare Provider Details

I. General information

NPI: 1972750032
Provider Name (Legal Business Name): RAHMATULLAH ISHAQZAY M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2008
Last Update Date: 08/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12011 LEE JACKSON MEMORIAL HWY
FAIRFAX VA
22033-3310
US

IV. Provider business mailing address

12011 LEE JACKSON MEMORIAL HWY
FAIRFAX VA
22033-3310
US

V. Phone/Fax

Practice location:
  • Phone: 703-385-8378
  • Fax: 703-385-9760
Mailing address:
  • Phone: 703-385-8378
  • Fax: 703-385-9760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0005X
TaxonomyAmbulatory Family Planning Facility
License Number0101243451
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: