Provider Demographics
NPI:1134132319
Name:FAIZ, HOSSEIN (MD)
Entity Type:Individual
Prefix:DR
First Name:HOSSEIN
Middle Name:
Last Name:FAIZ
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:PO BOX 606
Mailing Address - Street 2:
Mailing Address - City:PENNINGTON GAP
Mailing Address - State:VA
Mailing Address - Zip Code:24277
Mailing Address - Country:US
Mailing Address - Phone:276-546-5488
Mailing Address - Fax:276-546-4636
Practice Address - Street 1:LEE REGIONAL MEDICAL CENTER 1800 COMBS RD
Practice Address - Street 2:MEDICAL ARTS PLAZA SUITE 2
Practice Address - City:PENNINGTON GAP
Practice Address - State:VA
Practice Address - Zip Code:24277
Practice Address - Country:US
Practice Address - Phone:276-546-5488
Practice Address - Fax:276-546-4636
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101024572208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAB57876Medicare UPIN