Provider Demographics
NPI:1053972190
Name:IFTIKHAR, MARIA (PA)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:IFTIKHAR
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:224D CORNWALL ST NW STE 403
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-2704
Mailing Address - Country:US
Mailing Address - Phone:703-737-6010
Mailing Address - Fax:571-291-9786
Practice Address - Street 1:19415 DEERFIELD AVE SUITE 213
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-8470
Practice Address - Country:US
Practice Address - Phone:703-729-9220
Practice Address - Fax:703-858-3529
Is Sole Proprietor?:No
Enumeration Date:2019-06-27
Last Update Date:2024-03-07
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA30016079970002Medicaid
VA1053972190Medicaid