Provider Demographics
NPI:1801090964
Name:FATIMA, JAVAIRIAH (MD)
Entity type:Individual
Prefix:
First Name:JAVAIRIAH
Middle Name:
Last Name:FATIMA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7841 MONTVALE WAY
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-2030
Mailing Address - Country:US
Mailing Address - Phone:507-250-5160
Mailing Address - Fax:
Practice Address - Street 1:41 GERMANTOWN RD STE 101
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-4087
Practice Address - Country:US
Practice Address - Phone:507-250-5160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN51906208600000X
FLME1188452086S0129X
CT808922086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAENROLLEDMedicaid
FL012132000Medicaid
MNENROLLEDMedicaid
FL012132000Medicaid
IAENROLLEDMedicaid