Healthcare Provider Details

I. General information

NPI: 1134511835
Provider Name (Legal Business Name): INFECTIOUS DISEASE:TROPICAL MEDICINE AND TRAVELERS HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2015
Last Update Date: 03/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44035 RIVERSIDE PKWY SUITE 440
LEESBURG VA
20176-8260
US

IV. Provider business mailing address

44035 RIVERSIDE PKWY SUITE 440
LEESBURG VA
20176-8260
US

V. Phone/Fax

Practice location:
  • Phone: 703-858-9966
  • Fax: 702-858-9166
Mailing address:
  • Phone: 703-858-9966
  • Fax: 703-858-9177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number0101234174
License Number StateVA

VIII. Authorized Official

Name: SARFRAZ CHOUDHARY
Title or Position: CEO
Credential: M.D.
Phone: 703-858-9966