Provider Demographics
NPI:1588697668
Name:ISHAQ, SYED N (MD)
Entity type:Individual
Prefix:
First Name:SYED
Middle Name:N
Last Name:ISHAQ
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 1:41350 SPRINGFIELD LN
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20175-8743
Mailing Address - Country:US
Mailing Address - Phone:703-973-5790
Mailing Address - Fax:703-620-6628
Practice Address - Street 1:41350 SPRINGFIELD LN
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20175-8743
Practice Address - Country:US
Practice Address - Phone:703-973-5790
Practice Address - Fax:703-620-6628
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101058320174400000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005859671Medicaid
H43723Medicare UPIN
DCG02333A01Medicare PIN