Healthcare Provider Details

I. General information

NPI: 1588677959
Provider Name (Legal Business Name): SEDDIGHEH A. FEISEE MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 07/24/2024
Certification Date: 07/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 MAPLE AVE W STE 420
VIENNA VA
22180-4301
US

IV. Provider business mailing address

301 MAPLE AVE W STE 420
VIENNA VA
22180-4301
US

V. Phone/Fax

Practice location:
  • Phone: 703-569-4133
  • Fax: 703-440-8829
Mailing address:
  • Phone: 703-319-4162
  • Fax: 703-319-4163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101025770
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number0101025770
License Number StateVA

VIII. Authorized Official

Name: DR. SEDDIGHEH A. FEISEE
Title or Position: OWNER
Credential:
Phone: 703-569-4133