Provider Demographics
NPI:1790831295
Name:MIRZA S BAIG MD PC
Entity type:Organization
Organization Name:MIRZA S BAIG MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MIRZA
Authorized Official - Middle Name:S
Authorized Official - Last Name:BAIG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-256-6010
Mailing Address - Street 1:7501 LITTLE RIVER TPKE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-2923
Mailing Address - Country:US
Mailing Address - Phone:703-256-6010
Mailing Address - Fax:703-256-8684
Practice Address - Street 1:7501 LITTLE RIVER TPKE
Practice Address - Street 2:SUITE 104
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-2923
Practice Address - Country:US
Practice Address - Phone:703-256-6010
Practice Address - Fax:703-256-8684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101055095207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAG00663Medicare ID - Type Unspecified
G50012Medicare UPIN