Provider Demographics
NPI:1164754255
Name:ASHBURN STERLING DOCTORS
Entity Type:Organization
Organization Name:ASHBURN STERLING DOCTORS
Other - Org Name:ASHBURN INTERNAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:WASIQUE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:571-223-5610
Mailing Address - Street 1:42908 VESTALS GAP DR
Mailing Address - Street 2:
Mailing Address - City:BROADLANDS
Mailing Address - State:VA
Mailing Address - Zip Code:20148-4005
Mailing Address - Country:US
Mailing Address - Phone:571-223-5610
Mailing Address - Fax:571-287-6792
Practice Address - Street 1:21785 FILIGREE CT
Practice Address - Street 2:SUITE 215
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-6213
Practice Address - Country:US
Practice Address - Phone:571-223-5610
Practice Address - Fax:571-287-6792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-01
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101241267261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKI26330Medicare UPIN