Provider Demographics
NPI:1972607281
Name:MOHAMMED H. AZIM M.D. AND AHMAD Z. QASIMYAR M.D. PC
Entity Type:Organization
Organization Name:MOHAMMED H. AZIM M.D. AND AHMAD Z. QASIMYAR M.D. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMED
Authorized Official - Middle Name:HARDON
Authorized Official - Last Name:AZIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-257-1996
Mailing Address - Street 1:8694 CENTREVILLE RD
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-5266
Mailing Address - Country:US
Mailing Address - Phone:703-257-1996
Mailing Address - Fax:703-361-6078
Practice Address - Street 1:8694 CENTREVILLE RD
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-5266
Practice Address - Country:US
Practice Address - Phone:703-257-1996
Practice Address - Fax:703-361-6078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101236183207Q00000X
VA0101049112207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
F14078Medicare UPIN