Healthcare Provider Details

I. General information

NPI: 1285320366
Provider Name (Legal Business Name): FARISHTA BOURA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2023
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15742 SILENT TREE PL
WOODBRIDGE VA
22191-4276
US

IV. Provider business mailing address

15742 SILENT TREE PL
WOODBRIDGE VA
22191-4276
US

V. Phone/Fax

Practice location:
  • Phone: 571-641-0040
  • Fax: 571-641-0040
Mailing address:
  • Phone:
  • Fax: 571-641-0040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: