Healthcare Provider Details

I. General information

NPI: 1467366633
Provider Name (Legal Business Name): DR. ANIS ASSAD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CENTER DR
BETHESDA MD
20892-0004
US

IV. Provider business mailing address

4735 CARTERWOOD DR
FAIRFAX VA
22032-2414
US

V. Phone/Fax

Practice location:
  • Phone: 514-804-6794
  • Fax:
Mailing address:
  • Phone: 514-804-6794
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberMD600005866
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: