Provider Demographics
NPI:1588677959
Name:SEDDIGHEH A. FEISEE MD PC
Entity type:Organization
Organization Name:SEDDIGHEH A. FEISEE MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SEDDIGHEH
Authorized Official - Middle Name:A
Authorized Official - Last Name:FEISEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-569-4133
Mailing Address - Street 1:301 MAPLE AVE W STE 420
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-4301
Mailing Address - Country:US
Mailing Address - Phone:703-319-4162
Mailing Address - Fax:703-319-4163
Practice Address - Street 1:301 MAPLE AVE W STE 420
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-4301
Practice Address - Country:US
Practice Address - Phone:703-569-4133
Practice Address - Fax:703-440-8829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101025770310400000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No310400000XNursing & Custodial Care FacilitiesAssisted Living FacilityGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010315336Medicaid
VA010090326Medicaid
VA49D0716392OtherCLINICAL LABARATORY IMPROVEMENT AMENDMENTS (CLIA)
VA006060277Medicaid
VA49D0716392OtherCLINICAL LABARATORY IMPROVEMENT AMENDMENTS (CLIA)