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General NPI Number Information
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NPI Number | 1689802647
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Entity Type | Individual
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Provider Name | ANDREA KASSIM M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/30/2009
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Last Update Date | 12/17/2025
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Provider Practice Location Address
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Address Line | 4375 FAIR LAKES CT FL 3
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City | FAIRFAX
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State | VA
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Zip | 22033-4234
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Country | US
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Telephone | 571-432-2600
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Fax |
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Provider Business Mailing Address
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Address Line | 9230 OLD KEENE MILL RD # 1036
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City | BURKE
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State | VA
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Zip | 22015-4201
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Country | US
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Telephone | 571-432-2600
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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 | 2083A0300X
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Taxonomy Name | Addiction Medicine (Preventive Medicine) Physician
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License Number | 0101272756
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 266015
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 0101272756
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License Number State | VA
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Taxonomy #4
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 25MA09182700
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License Number State | NJ
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