Healthcare Provider Details

I. General information

NPI: 1972206050
Provider Name (Legal Business Name): ZACKARIA NIAZI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12480 DILLINGHAM SQ
WOODBRIDGE VA
22192-5258
US

IV. Provider business mailing address

12480 DILLINGHAM SQ
WOODBRIDGE VA
22192-5258
US

V. Phone/Fax

Practice location:
  • Phone: 703-494-6111
  • Fax: 571-665-6667
Mailing address:
  • Phone: 703-494-6111
  • Fax: 571-665-6667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number125.081671
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: