Provider Demographics
NPI:1487493359
Name:RASLAN, WASIM FAWZI (MD)
Entity type:Individual
Prefix:
First Name:WASIM
Middle Name:FAWZI
Last Name:RASLAN
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 1:4689 LONGSTREET LN APT 303
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22311-4934
Mailing Address - Country:US
Mailing Address - Phone:571-480-0086
Mailing Address - Fax:
Practice Address - Street 1:4689 LONGSTREET LN APT 303
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22311-4934
Practice Address - Country:US
Practice Address - Phone:571-480-0086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-21
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036074036207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology