Healthcare Provider Details

I. General information

NPI: 1366980633
Provider Name (Legal Business Name): WASEEM I AZIZ MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2017
Last Update Date: 02/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44045 RIVERSIDE PKWY
LEESBURG VA
20176-5101
US

IV. Provider business mailing address

714 WALKER RD
GREAT FALLS VA
22066-2802
US

V. Phone/Fax

Practice location:
  • Phone: 703-609-6362
  • Fax:
Mailing address:
  • Phone: 703-609-6392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number0101238422
License Number StateVA

VIII. Authorized Official

Name: DR. WASEEM ISMAIL AZIZ
Title or Position: PRESIDENT
Credential: MD
Phone: 703-609-6362