Basic Information
| Provider Information | |||||||||
| NPI: | 1619358264 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STANAZAI | ||||||||
| FirstName: | HASHIM | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1301 3RD ST | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | WICHITA FALLS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 763012245 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9407675145 | ||||||||
| FaxNumber: | 9407673027 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 N SHENANDOAH AVE | ||||||||
| Address2: | |||||||||
| City: | FRONT ROYAL | ||||||||
| State: | VA | ||||||||
| PostalCode: | 226303547 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5406360300 | ||||||||
| FaxNumber: | 5406360427 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2015 | ||||||||
| LastUpdateDate: | 03/17/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | BP10051982 | TX | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | FS7258963 | VA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | FS7258963 | 01 | VA | DEA | OTHER |