Healthcare Provider Details

I. General information

NPI: 1578772596
Provider Name (Legal Business Name): ALIFIYA A TYABJI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALIFIYA J POONAWALA MD

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6120 BRANDON AVE STE 308
SPRINGFIELD VA
22150-2504
US

IV. Provider business mailing address

6120 BRANDON AVE STE 308
SPRINGFIELD VA
22150-2504
US

V. Phone/Fax

Practice location:
  • Phone: 703-451-3333
  • Fax: 703-451-7219
Mailing address:
  • Phone: 703-451-3333
  • Fax: 703-451-7219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101241615
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: