Provider Demographics
NPI:1285879981
Name:PERVAIZ, SABEEN (MD)
Entity type:Individual
Prefix:
First Name:SABEEN
Middle Name:
Last Name:PERVAIZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4041 UNIVERSITY DR STE 405
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-3410
Mailing Address - Country:US
Mailing Address - Phone:571-620-5393
Mailing Address - Fax:
Practice Address - Street 1:4041 UNIVERSITY DR STE 405
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-3410
Practice Address - Country:US
Practice Address - Phone:571-620-5393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-09
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08798700207Q00000X
VA0101254065207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0269433Medicaid
NJ8751404Medicaid