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Individual

DR. FADY IHSAN SHARARA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
11150 SUNSET HILLS RD, SUITE 100, RESTON, VA 20190-5360
(703) 437-7722
(703) 437-0066
Mailing address
11150 SUNSET HILLS RD, SUITE 100, RESTON, VA 20190-5360
(703) 437-7722
(703) 437-0066

Taxonomy

Speciality
Code
Description
License number
State
207VE0102X
Reproductive Endocrinology Physician
Primary
0101058651
VA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
391589
ALLIANCE MAMSI PROVIDER#
VA
01
440239
ATHEM PROVIDER #
VA
Enumeration date
06/24/2006
Last updated
07/08/2007
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