Provider Demographics
NPI:1225024748
Name:FAZEL, ALI (MD)
Entity Type:Individual
Prefix:DR
First Name:ALI
Middle Name:
Last Name:FAZEL
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 1:8501 ARLINGTON BLVD
Mailing Address - Street 2:SUITE 525
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4617
Mailing Address - Country:US
Mailing Address - Phone:703-494-3199
Mailing Address - Fax:703-494-6766
Practice Address - Street 1:8501 ARLINGTON BLVD
Practice Address - Street 2:SUITE 525
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4617
Practice Address - Country:US
Practice Address - Phone:703-494-3199
Practice Address - Fax:703-494-6766
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0063370207RG0100X
VA0101238145207RG0100X
FLME85544207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG37168Medicare UPIN
DC018465M92Medicare PIN
MD454LM931Medicare PIN