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General NPI Number Information
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NPI Number | 1669747036
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Entity Type | Organization
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Legal Business Name | TYSONS MEDICAL GROUP
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Dates
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Enumeration Date | 03/17/2012
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Last Update Date | 03/17/2012
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Provider Practice Location Address
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Address Line | 8206 LEESBURG PIKE SUITE 302
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City | VIENNA
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State | VA
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Zip | 22182-2614
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Country | US
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Telephone | 703-436-8000
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Fax | 703-291-3311
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Provider Business Mailing Address
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Address Line | 8206 LEESBURG PIKE SUITE 302
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City | VIENNA
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State | VA
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Zip | 22182-2614
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Country | US
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Telephone | 703-436-8000
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Fax | 703-291-3311
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Authorized Official
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Title or Position | FOUNDER
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Name | FAIZA KADA
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Credential | M.D.
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Telephone | 703-436-8000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 0101235827
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License Number State | VA
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