Healthcare Provider Details

I. General information

NPI: 1912815929
Provider Name (Legal Business Name): RANA NASSR HUSSEIN FADAH PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2206 EXECUTIVE DR
HAMPTON VA
23666-2583
US

IV. Provider business mailing address

1 TRITON WAY
HAMPTON VA
23666-5570
US

V. Phone/Fax

Practice location:
  • Phone: 757-825-1440
  • Fax:
Mailing address:
  • Phone: 757-755-6526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110012267
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: