Healthcare Provider Details

I. General information

NPI: 1215060553
Provider Name (Legal Business Name): MAHMOOD GHAUS AIJAZI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 05/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1980 GALLOWS RD
TYSONS CORNER VA
22182-3913
US

IV. Provider business mailing address

13426 ALFRED MILL CT
HERNDON VA
20171-3623
US

V. Phone/Fax

Practice location:
  • Phone: 703-662-3020
  • Fax:
Mailing address:
  • Phone: 571-203-9277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License Number0101232202
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: