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General NPI Number Information
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NPI Number | 1811082068
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Entity Type | Organization
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Legal Business Name | GREATER WASHINGTON GASTROENTEROLOGY
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 8501 ARLINGTON BLVD SUITE 525
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City | FAIRFAX
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State | VA
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Zip | 22031-4617
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Country | US
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Telephone | 703-645-9790
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Fax | 703-645-9793
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Provider Business Mailing Address
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Address Line | 8501 ARLINGTON BLVD SUITE 525
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City | FAIRFAX
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State | VA
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Zip | 22031-4617
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Country | US
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Telephone | 703-645-9790
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Fax | 703-645-9793
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Authorized Official
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Title or Position | OWNER
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Name | DR. ALI FAZEL
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Credential | M.D.
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Telephone | 703-645-9790
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | D0063370
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License Number State | MD
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