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NPI Code Detail

MEDICARE: MRS. NIDA GULFAM D.O.

MEDICARE: MRS. NIDA GULFAM D.O.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0800XPsychiatry Physician102208421VA
22084P0800XPsychiatry Physician0102208421VA

General Provider Information

NPI Number : 1700414737
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. NIDA GULFAM D.O.
Provider Business Mailing Address
First Line : 13285 MINNIEVILLE RD.
Second Line :
City : WOODBRIDGE
State : VA
Zip : 22192
Country : US
Telephone Number : 800-777-7904
Fax Number : 844-785-2180
Provider Business Practice Location Address
First Line : 13285 MINNIEVILLE RD
Second Line :
City : WOODBRIDGE
State : VA
Zip : 22192-4018
Country : US
Telephone Number : 800-777-7904
Fax Number : 844-785-2180
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/27/2020
Last Update Date : 06/01/2026

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