Individual
SUBASH B. BAZAZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
44035 RIVERSIDE PKWY, STE 400, LEESBURG, VA 20176-8260
(703) 858-5421
(703) 858-9573
Mailing address
2901 TELESTAR CT., #300, FALLS CHURCH, VA 22042-1261
(703) 591-1688
(703) 591-1445
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
0101232467
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
034162800
—
DC
01
—
060066479
RAILROAD MEDICARE DC #
DC
01
—
060066480
RAILROAD MEDICARE VA #
VA
05
—
1619971264
—
VA
05
—
487504400
—
MD
Enumeration date
06/10/2005
Last updated
07/14/2023
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