Provider Demographics
NPI:1063469393
Name:MIRZA, SOHAIL K (MD, MPH)
Entity Type:Individual
Prefix:
First Name:SOHAIL
Middle Name:K
Last Name:MIRZA
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4250 CHAIN BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-4214
Mailing Address - Country:US
Mailing Address - Phone:703-828-6579
Mailing Address - Fax:571-458-7336
Practice Address - Street 1:4250 CHAIN BRIDGE RD
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-4214
Practice Address - Country:US
Practice Address - Phone:703-828-6579
Practice Address - Fax:571-458-7336
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA79228207XS0117X
NH14258207XS0117X
VA0101261117207XS0117X
CA79154 8002207XS0117X
CO34710207XS0117X
WAMD00031150207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1015431Medicaid
NH30208086Medicaid
NH000791601Medicare PIN
NH30208086Medicaid