Provider Demographics
NPI:1164659934
Name:FAQIRI, SOSUN Z (MD)
Entity Type:Individual
Prefix:MRS
First Name:SOSUN
Middle Name:Z
Last Name:FAQIRI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:SOSUN
Other - Middle Name:
Other - Last Name:ZIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:161 FORT EVANS ROAD NE
Mailing Address - Street 2:SUITE 330
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176
Mailing Address - Country:US
Mailing Address - Phone:703-777-5224
Mailing Address - Fax:703-777-5227
Practice Address - Street 1:161 FORT EVANS ROAD NE
Practice Address - Street 2:SUITE 330
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176
Practice Address - Country:US
Practice Address - Phone:703-777-5224
Practice Address - Fax:703-777-5227
Is Sole Proprietor?:No
Enumeration Date:2009-06-18
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJPERMIT208000000X
DEC10009218208000000X, 208D00000X
VA10101251326208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice