Provider Demographics
NPI:1396130738
Name:BISMILAH MEDICAL LLC
Entity type:Organization
Organization Name:BISMILAH MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SYED
Authorized Official - Middle Name:S
Authorized Official - Last Name:HASSAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-635-2775
Mailing Address - Street 1:5501 CHEROKEE AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22312-2305
Mailing Address - Country:US
Mailing Address - Phone:703-635-2775
Mailing Address - Fax:703-348-7492
Practice Address - Street 1:5501 CHEROKEE AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22312-2305
Practice Address - Country:US
Practice Address - Phone:703-635-2775
Practice Address - Fax:703-348-7492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-02
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101225821261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAB35991Medicare UPIN