Provider Demographics
NPI:1659427896
Name:FOZDAR, PRATIMA SINGH (MD)
Entity Type:Individual
Prefix:DR
First Name:PRATIMA
Middle Name:SINGH
Last Name:FOZDAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4921 SEMINARY RD
Mailing Address - Street 2:117
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22311-1838
Mailing Address - Country:US
Mailing Address - Phone:703-820-1406
Mailing Address - Fax:703-931-8032
Practice Address - Street 1:4921 SEMINARY RD
Practice Address - Street 2:117
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22311-1838
Practice Address - Country:US
Practice Address - Phone:703-820-1406
Practice Address - Fax:703-931-8032
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101037915207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAB62163Medicare UPIN
VA187598Medicare ID - Type Unspecified