Healthcare Provider Details

I. General information

NPI: 1205684636
Provider Name (Legal Business Name): FAHMINA HASAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: FAHMINA MAJUMDAR

II. Dates (important events)

Enumeration Date: 05/09/2024
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14800 LEE HWY
GAINESVILLE VA
20155-1842
US

IV. Provider business mailing address

24560 SOUTHPOINT DR STE 200
ALDIE VA
20105-3505
US

V. Phone/Fax

Practice location:
  • Phone: 703-743-7017
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110009847
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: