Provider Demographics
NPI:1811237308
Name:MUTAHAR FAUZIA MD
Entity Type:Organization
Organization Name:MUTAHAR FAUZIA MD
Other - Org Name:VIRGINIA WOMEN CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MUTAHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:FAUZIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-845-3400
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-21
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101037011207R00000X, 207V00000X, 207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Multi-Specialty