Provider Demographics
NPI:1184917171
Name:JAVAID, ZEESHAN (MD)
Entity type:Individual
Prefix:
First Name:ZEESHAN
Middle Name:
Last Name:JAVAID
Suffix:
Gender:M
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:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:571-284-4245
Mailing Address - Fax:571-364-8886
Practice Address - Street 1:10322 BRISTOW CENTER DR
Practice Address - Street 2:
Practice Address - City:BRISTOW
Practice Address - State:VA
Practice Address - Zip Code:20136-2201
Practice Address - Country:US
Practice Address - Phone:571-284-4245
Practice Address - Fax:571-364-8886
Is Sole Proprietor?:No
Enumeration Date:2011-05-24
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD452587207Q00000X
KYR2776390200000X
VA0101259628207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP01209694OtherMEDICARE RAILROAD
KYK054131Medicare PIN
KYP01209694OtherMEDICARE RAILROAD
KYK054132Medicare PIN