Healthcare Provider Details

I. General information

NPI: 1679406904
Provider Name (Legal Business Name): MAQBUL MOHAMMAD SAFI PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8100 ASHTON AVE STE 200
MANASSAS VA
20109-5688
US

IV. Provider business mailing address

8100 ASHTON AVE STE 200
MANASSAS VA
20109-5688
US

V. Phone/Fax

Practice location:
  • Phone: 571-581-1771
  • Fax:
Mailing address:
  • Phone: 571-581-1771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: