Provider Demographics
NPI:1669747036
Name:TYSONS MEDICAL GROUP
Entity type:Organization
Organization Name:TYSONS MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:FAIZA
Authorized Official - Middle Name:
Authorized Official - Last Name:KADA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-436-8000
Mailing Address - Street 1:8206 LEESBURG PIKE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2614
Mailing Address - Country:US
Mailing Address - Phone:703-436-8000
Mailing Address - Fax:703-291-3311
Practice Address - Street 1:8206 LEESBURG PIKE
Practice Address - Street 2:SUITE 302
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-2614
Practice Address - Country:US
Practice Address - Phone:703-436-8000
Practice Address - Fax:703-291-3311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-17
Last Update Date:2012-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101235827207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty