Provider Demographics
NPI:1205684636
Name:HASAN, FAHMINA
Entity type:Individual
Prefix:
First Name:FAHMINA
Middle Name:
Last Name:HASAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:FAHMINA
Other - Middle Name:
Other - Last Name:MAJUMDAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:24560 SOUTHPOINT DR STE 200
Mailing Address - Street 2:
Mailing Address - City:ALDIE
Mailing Address - State:VA
Mailing Address - Zip Code:20105-3505
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14800 LEE HWY
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20155-1842
Practice Address - Country:US
Practice Address - Phone:703-743-7017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-09
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110009847363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant