1548742133 NPI number — HENA ISLAM AHSAN MSN, NP-C

Table of content: HENA ISLAM AHSAN MSN, NP-C (NPI 1548742133)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548742133 NPI number — HENA ISLAM AHSAN MSN, NP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AHSAN
Provider First Name:
HENA
Provider Middle Name:
ISLAM
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSN, NP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548742133
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/09/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
224D CORNWALL ST NW STE 403
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEESBURG
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20176-2704
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-737-6010
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19450 DEERFIELD AVENUE
Provider Second Line Business Practice Location Address:
SUITE 265
Provider Business Practice Location Address City Name:
LEESBURG
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20176-5179
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-858-3060
Provider Business Practice Location Address Fax Number:
703-858-3061
Provider Enumeration Date:
08/30/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  0024176386 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1548742133 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 30015468390001 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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