Provider Demographics
NPI:1235229519
Name:TAHIRA, MUSSARAT (MD)
Entity Type:Individual
Prefix:
First Name:MUSSARAT
Middle Name:
Last Name:TAHIRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6593 IRVIN CT
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22312-2235
Mailing Address - Country:US
Mailing Address - Phone:703-658-2132
Mailing Address - Fax:
Practice Address - Street 1:611 S CARLIN SPRINGS RD
Practice Address - Street 2:SUITE # 514
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22204-1064
Practice Address - Country:US
Practice Address - Phone:703-671-5200
Practice Address - Fax:703-671-5255
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-14
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101053755207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005820936Medicaid
G61391Medicare UPIN
VAG01644Medicare ID - Type Unspecified