Healthcare Provider Details

I. General information

NPI: 1306774807
Provider Name (Legal Business Name): ABDUL HASEEB HASAN MBBS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2280 OPITZ BLVD SUITE 110, GRADUATE MEDICAL EDUCATION
WOODBRIDGE VA
22191
US

IV. Provider business mailing address

2280 OPITZ BLVD SUITE 110, GRADUATE MEDICAL EDUCATION
WOODBRIDGE VA
22191
US

V. Phone/Fax

Practice location:
  • Phone: 703-523-1409
  • Fax:
Mailing address:
  • Phone: 703-523-1409
  • Fax:

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: