Healthcare Provider Details

I. General information

NPI: 1700414307
Provider Name (Legal Business Name): ZACHARIAH HASAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2020
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

722 GRANT ST STE F
HERNDON VA
20170-4533
US

IV. Provider business mailing address

722 GRANT ST STE F
HERNDON VA
20170-4533
US

V. Phone/Fax

Practice location:
  • Phone: 703-787-7638
  • Fax:
Mailing address:
  • Phone: 703-787-7638
  • Fax: 703-787-7654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number0101281965
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: