Provider Demographics
NPI:1023008976
Name:HUSSAIN, NIZAR MOHAMED (MD)
Entity Type:Individual
Prefix:DR
First Name:NIZAR
Middle Name:MOHAMED
Last Name:HUSSAIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 OPITZ BLVD
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-3306
Mailing Address - Country:US
Mailing Address - Phone:703-499-9144
Mailing Address - Fax:703-497-0051
Practice Address - Street 1:2000 OPITZ BLVD
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-3306
Practice Address - Country:US
Practice Address - Phone:703-494-4116
Practice Address - Fax:703-497-0051
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101225617207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0102215188Medicaid
H23714Medicare UPIN