Healthcare Provider Details

I. General information

NPI: 1073984126
Provider Name (Legal Business Name): JEAN OBEISSANT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2015
Last Update Date: 10/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 23RD ST NW
WASHINGTON DC
20037-2342
US

IV. Provider business mailing address

7731 INVERSHAM DR # 162
FALLS CHURCH VA
22042-4447
US

V. Phone/Fax

Practice location:
  • Phone: 202-715-4500
  • Fax:
Mailing address:
  • Phone: 240-723-6442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License NumberSA0123
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: