Provider Demographics
NPI:1336588367
Name:GEORGE MASON UNIVERSITY STUDENT HEALTH SERVICE
Entity Type:Organization
Organization Name:GEORGE MASON UNIVERSITY STUDENT HEALTH SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WAGIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDALLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-993-2831
Mailing Address - Street 1:4400 UNIVERSITY DR
Mailing Address - Street 2:MS 2 D3
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-4422
Mailing Address - Country:US
Mailing Address - Phone:703-993-2831
Mailing Address - Fax:703-993-4365
Practice Address - Street 1:4400 UNIVERSITY DR
Practice Address - Street 2:MS 2 D3
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-4422
Practice Address - Country:US
Practice Address - Phone:703-993-2831
Practice Address - Fax:703-993-4365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-24
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health