Healthcare Provider Details

I. General information

NPI: 1518224559
Provider Name (Legal Business Name): QAMAR RAZA FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2012
Last Update Date: 09/13/2022
Certification Date: 09/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 GALLOWS RD
FALLS CHURCH VA
22042-3307
US

IV. Provider business mailing address

PO BOX 37174
BALTIMORE MD
21297-3174
US

V. Phone/Fax

Practice location:
  • Phone: 703-776-4001
  • Fax:
Mailing address:
  • Phone: 703-820-1900
  • Fax: 866-528-6229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024169740
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024169740
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code364SP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist
License Number0024169740
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number0024169740
License Number StateVA
# 5
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number0024169740
License Number StateVA
# 6
Primary TaxonomyN
Taxonomy Code364SP0810X
TaxonomyChild & Family Psychiatric/Mental Health Clinical Nurse Specialist
License Number0024169740
License Number StateVA
# 7
Primary TaxonomyN
Taxonomy Code364SP0811X
TaxonomyChronically Ill Psychiatric/Mental Health Clinical Nurse Specialist
License Number0024169740
License Number StateVA
# 8
Primary TaxonomyN
Taxonomy Code364SP0812X
TaxonomyCommunity Psychiatric/Mental Health Clinical Nurse Specialist
License Number0024169740
License Number StateVA
# 9
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number0024169740
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: