Healthcare Provider Details

I. General information

NPI: 1588697668
Provider Name (Legal Business Name): SYED N ISHAQ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 05/02/2024
Certification Date: 05/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41350 SPRINGFIELD LN
LEESBURG VA
20175-8743
US

IV. Provider business mailing address

41350 SPRINGFIELD LN
LEESBURG VA
20175-8743
US

V. Phone/Fax

Practice location:
  • Phone: 703-973-5790
  • Fax: 703-620-6628
Mailing address:
  • Phone: 703-973-5790
  • Fax: 703-620-6628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number0101058320
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101058320
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: