Healthcare Provider Details

I. General information

NPI: 1255372231
Provider Name (Legal Business Name): SYED S HASSAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 03/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13319 WOODBRIDGE ST
WOODBRIDGE VA
22191-1608
US

IV. Provider business mailing address

13319 WOODBRIDGE ST
WOODBRIDGE VA
22191-1608
US

V. Phone/Fax

Practice location:
  • Phone: 703-499-9921
  • Fax: 703-499-9951
Mailing address:
  • Phone: 703-499-9921
  • Fax: 703-499-9951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License Number0101225821
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: