Healthcare Provider Details

I. General information

NPI: 1336588367
Provider Name (Legal Business Name): GEORGE MASON UNIVERSITY STUDENT HEALTH SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2013
Last Update Date: 06/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 UNIVERSITY DR MS 2 D3
FAIRFAX VA
22030-4422
US

IV. Provider business mailing address

4400 UNIVERSITY DR MS 2 D3
FAIRFAX VA
22030-4422
US

V. Phone/Fax

Practice location:
  • Phone: 703-993-2831
  • Fax: 703-993-4365
Mailing address:
  • Phone: 703-993-2831
  • Fax: 703-993-4365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: WAGIDA ABDALLA
Title or Position: EXECUTIVE DIRECTOR
Credential: M.D.
Phone: 703-993-2831