Healthcare Provider Details

I. General information

NPI: 1225977341
Provider Name (Legal Business Name): FIZZA TAHIR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2026
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 J. CLYDE MORRIS BLVD. RRMC DEPT. OF MEDICAL EDUCATION (ANNEX, 2ND FLOOR)
NEWPORT NEWS VA
23601
US

IV. Provider business mailing address

10105 TASKER DR
MANASSAS VA
20109-2927
US

V. Phone/Fax

Practice location:
  • Phone: 757-594-3945
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: