Provider Demographics
NPI:1578772596
Name:TYABJI, ALIFIYA A (MD)
Entity type:Individual
Prefix:
First Name:ALIFIYA
Middle Name:A
Last Name:TYABJI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ALIFIYA
Other - Middle Name:J
Other - Last Name:POONAWALA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6120 BRANDON AVE STE 308
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22150-2504
Mailing Address - Country:US
Mailing Address - Phone:703-451-3333
Mailing Address - Fax:703-451-7219
Practice Address - Street 1:6120 BRANDON AVE STE 308
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22150-2504
Practice Address - Country:US
Practice Address - Phone:703-451-3333
Practice Address - Fax:703-451-7219
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101241615208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1578772596Medicaid
NVCS15542OtherSTATE PHARMACY
CO45229350Medicaid
NV12436OtherMEDICAL LICENSE
NV1578772596Medicaid
NVCS15542OtherSTATE PHARMACY