Healthcare Provider Details

I. General information

NPI: 1326556150
Provider Name (Legal Business Name): FATIMA AMIR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2018
Last Update Date: 02/09/2021
Certification Date: 02/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 TOWN CENTER PKWY
RESTON VA
20190-3298
US

IV. Provider business mailing address

9291 TOWER SIDE DR APT 316
FAIRFAX VA
22031-6024
US

V. Phone/Fax

Practice location:
  • Phone: 703-689-9037
  • Fax:
Mailing address:
  • Phone: 443-846-1909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number010127117
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number010127117
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: