Kaniz Fatema, MD
Individual provider Active NPI Family Medicine Physician · Woodbridge, VA
NPI 1356548366 · NPPES record last updated Nov 5, 2018
Key facts
- NPI
- 1356548366
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 0101241486 (VA)
- Practice address
- 12581 Milstead Way Ste 103
Woodbridge, VA 22192-5446 - Phone
- (703) 437-6060
- NPI assigned
- Jul 2, 2007
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Interventional Pain Management
- Education
- Other
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Virginia Urgent Care LLC
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
Hospital & facility affiliations
- Sentara Northern Virginia Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110525000689 | VA | Practitioner - Interventional Pain Management | 4981880044 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Virginia Urgent Care LLC | Urgent Care | Current |
Accepting new patients |
Locations
330 White Oak Rd
Fredericksburg, VA 22405
Phone (540) 373-2424
15 S Gateway Dr
Ste 101
Fredericksburg, VA 22406
Phone (540) 368-5603
5825 Plank Rd
Ste 105
Fredericksburg, VA 22407
Phone (540) 785-2727
12581 Milstead Way
Ste 103
Woodbridge, VA 22192
Phone (703) 897-5890
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Urgent Care Clinic/Center | 261QU0200X | 0101241486 | VA | |
| Family Medicine Physician | 207Q00000X | 0101241486 | VA | Yes |
Addresses
Primary practice location
12581 Milstead Way Ste 103
Woodbridge, VA 22192-5446
Mailing address
9527 Parsonage LN
Lorton, VA 22079-2776
Phone (703) 646-5494
Other providers in Woodbridge, VA
- Jon M Farber
- Maidah Farooq
- Muazzam Farooq
- Atoussa Farough
- Zohreh Farzad
- Hadi Fathalikhani
- Fatherandsoncom
- Andre F Feltren
- Yordanos Fente
- Breanna Ferguson
All providers in Woodbridge, VA · Family Medicine Physician in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 5, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.