Healthcare Provider Details

I. General information

NPI: 1841684735
Provider Name (Legal Business Name): LAEEQ AHMED BUTT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2015
Last Update Date: 02/20/2025
Certification Date: 02/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45929 MARIES RD STE 100
STERLING VA
20166-9299
US

IV. Provider business mailing address

45929 MARIES RD STE 100
STERLING VA
20166-9299
US

V. Phone/Fax

Practice location:
  • Phone: 703-400-5314
  • Fax:
Mailing address:
  • Phone: 973-216-1489
  • 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 StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101273400
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME136025
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberC198559
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: