Healthcare Provider Details

I. General information

NPI: 1093955239
Provider Name (Legal Business Name): HESYRA MEDICAL ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2009
Last Update Date: 02/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 VAN DUSEN RD LAUREL REGIONAL HOSPITAL
LAUREL MD
20707-9463
US

IV. Provider business mailing address

8904 GARDEN GATE DR ATTN: DR M YACOUB
FAIRFAX VA
22031-1471
US

V. Phone/Fax

Practice location:
  • Phone: 301-497-7900
  • Fax:
Mailing address:
  • Phone: 703-960-8150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MINA M YACOUB
Title or Position: PRESIDENT
Credential: M.D.
Phone: 703-960-8150