Healthcare Provider Details

I. General information

NPI: 1124251798
Provider Name (Legal Business Name): DOUGLAS STEVEN NASSIF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2009
Last Update Date: 05/17/2022
Certification Date: 05/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 GALLOWS RD
FALLS CHURCH VA
22042-3307
US

IV. Provider business mailing address

1511 P ST NW
WASHINGTON DC
20005-1909
US

V. Phone/Fax

Practice location:
  • Phone: 703-776-6652
  • Fax:
Mailing address:
  • Phone: 517-303-1580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0116021230
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0101252907
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: