Individual provider Active NPI

Syed Wajahat Raza

  • Medical Physician Assistant
  • Fredericksburg, VA
National Provider Identifier
1245838994
Registry record updated Mar 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
0110010783 Issued in VA
Practice address
15 S Gateway Dr Ste 101
Fredericksburg, VA 22406-1231
Phone
(540) 368-5603
NPI assigned
Oct 14, 2020
Last updated
Mar 13, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 13, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 0110010783 VA Primary

Addresses

Primary practice location

15 S Gateway Dr Ste 101
Fredericksburg, VA 22406-1231

Mailing address

12029 Tango LN
Woodbridge, VA 22193-6111
Phone (210) 863-4904

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250411001005 VA Practitioner - Physician Assistant 0547784522 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Virginia Urgent Care LLCGroup PAC ID 2062572456, 24 clinicians

Practice addresses (Care Compare)

12581 Milstead Way
Suite 103
Woodbridge, VA 22192-5425
Phone (703) 897-5890

15 S Gateway Dr
Suite 101
Fredericksburg, VA 22406-1231
Phone (540) 368-5603

330 White Oak Rd
Fredericksburg, VA 22405-2792
Phone (540) 373-2424

3990 Fettler Park Dr
Dumfries, VA 22025-1997
Phone (571) 499-5813

5825 Plank Rd
Suite 105
Fredericksburg, VA 22407-5207
Phone (540) 785-2727

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
0110010783VAMDMedical Physician Assistant

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1602633600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741824000000",
    "number": "1245838994",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12029 TANGO LN",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221936111",
            "telephone_number": "210-863-4904"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 S GATEWAY DR STE 101",
            "city": "FREDERICKSBURG",
            "state": "VA",
            "postal_code": "224061231",
            "telephone_number": "540-368-5603"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAZA",
        "first_name": "SYED WAJAHAT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-10-14",
        "last_updated": "2025-03-13",
        "certification_date": "2025-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "VA",
            "license": "0110010783",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fredericksburg, VA

Sources for this page

Verify at the official NPI Registry.