Organization
CHANTILLY WALK-IN CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SAMIR NAZAM M.D. (PHYSICIAN)
(703) 631-0791
Entity
Organization
Contact information
Practice address
13037 LEE JACKSON HWY, STE D, FAIRFAX, VA 22033-2004
(703) 631-0791
(703) 968-4227
Mailing address
PO BOX 221226, CHANTILLY, VA 20153-1226
(703) 631-0791
(703) 968-4227
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
0101036326
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
292549
B/C PROVIDER #
VA
Enumeration date
06/24/2005
Last updated
08/22/2020
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