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General NPI Number Information
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NPI Number | 1578684841
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Entity Type | Individual
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Provider Name | SAMIR NAZAM M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 13037 LEE JACKSON MEMORIAL HWY STE D
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City | FAIRFAX
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State | VA
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Zip | 22033-2004
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Country | US
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Telephone | 703-631-0791
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Fax | 703-968-4227
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Provider Business Mailing Address
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Address Line | 10808 SUNSET HILLS RD
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City | RESTON
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State | VA
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Zip | 20190-5410
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Country | US
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Telephone | 703-438-3838
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0101036326
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License Number State | VA
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