MEDICARE: MUTAHAR FAUZIA MD

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
1	207R00000X	Internal Medicine Physician	0101037011	VA
2	207VE0102X	Reproductive Endocrinology Physician	0101037011	VA
3	207V00000X	Obstetrics & Gynecology Physician	0101037011	VA

General Provider Information

NPI Number	:	1811237308
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MUTAHAR FAUZIA MD

Provider Business Mailing Address
First Line	:	5697 COLUMBIA PIKE
Second Line	:	STE 100
City	:	FALLS CHURCH
State	:	VA
Zip	:	22041-2897
Country	:	US
Telephone Number	:	703-845-3400
Fax Number	:	800-485-0703

Provider Business Practice Location Address
First Line	:	5697 COLUMBIA PIKE
Second Line	:	STE 100
City	:	FALLS CHURCH
State	:	VA
Zip	:	22041-2897
Country	:	US
Telephone Number	:	703-845-3400
Fax Number	:	800-485-0703

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MUTAHAR FAUZIA
Credential	:	MD
Telephone Number	:	703-845-3400

Provider Enumeration Date	:	02/21/2013
Last Update Date	:	02/21/2013

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