Provider Demographics
NPI:1467454223
Name:FAUZIA, MUTAHAR (MD)
Entity Type:Individual
Prefix:DR
First Name:MUTAHAR
Middle Name:
Last Name:FAUZIA
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 1:5697 COLUMBIA PIKE
Mailing Address - Street 2:STE 100
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22041-2897
Mailing Address - Country:US
Mailing Address - Phone:703-845-3400
Mailing Address - Fax:800-485-0703
Practice Address - Street 1:5697 COLUMBIA PIKE
Practice Address - Street 2:STE 100
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22041-2897
Practice Address - Country:US
Practice Address - Phone:703-845-3400
Practice Address - Fax:800-485-0703
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101037011207R00000X, 207VE0102X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5320010OtherAETNA PPO INS ID
VA1456121OtherUNITED HEALTHCARE ID
VA205757OtherANTHEM BCBS ID
VA2340766OtherCIGNA INS ID
VA52300001OtherCAREFIRST BCBS ID
VA006213375Medicaid
VA1456121OtherUNITED HEALTHCARE ID
VA1456121OtherUNITED HEALTHCARE ID
VA006213375Medicaid