Provider Demographics
NPI:1780610352
Name:SHARARA, FADY IHSAN (MD)
Entity type:Individual
Prefix:DR
First Name:FADY
Middle Name:IHSAN
Last Name:SHARARA
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 1:11150 SUNSET HILLS RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-5360
Mailing Address - Country:US
Mailing Address - Phone:703-437-7722
Mailing Address - Fax:703-437-0066
Practice Address - Street 1:11150 SUNSET HILLS RD
Practice Address - Street 2:SUITE 100
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5360
Practice Address - Country:US
Practice Address - Phone:703-437-7722
Practice Address - Fax:703-437-0066
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101058651207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA391589OtherALLIANCE MAMSI PROVIDER#
VA440239OtherATHEM PROVIDER #
VA391589OtherOPT CHOICE MDIPA PROVIDER
F70886Medicare UPIN