Provider Demographics
NPI:1962583997
Name:MIRZA, FARHAT HASAN (MD)
Entity type:Individual
Prefix:
First Name:FARHAT
Middle Name:HASAN
Last Name:MIRZA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:FARHAT
Other - Middle Name:
Other - Last Name:HASAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:9510 ATWOOD RD
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-1403
Mailing Address - Country:US
Mailing Address - Phone:703-573-5242
Mailing Address - Fax:703-573-5242
Practice Address - Street 1:8901 WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20889-0001
Practice Address - Country:US
Practice Address - Phone:301-319-8342
Practice Address - Fax:301-319-4712
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101236910207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC037289500Medicaid
I23335Medicare UPIN