Healthcare Provider Details

I. General information

NPI: 1811152242
Provider Name (Legal Business Name): ESAM S. OMEISH, MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2008
Last Update Date: 07/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2849 DUKE ST SUITE 14
ALEXANDRIA VA
22314-4512
US

IV. Provider business mailing address

PO BOX 8325
FALLS CHURCH VA
22041-8325
US

V. Phone/Fax

Practice location:
  • Phone: 703-360-9700
  • Fax: 703-780-9229
Mailing address:
  • Phone: 703-360-9700
  • Fax: 703-780-9229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0101057717
License Number StateVA

VIII. Authorized Official

Name: DR. ESAM OMEISH
Title or Position: PRESIDENT
Credential:
Phone: 703-360-9700