Healthcare Provider Details

I. General information

NPI: 1639844095
Provider Name (Legal Business Name): AHMED HANI ASSAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2021
Last Update Date: 08/09/2021
Certification Date: 08/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 GALLOWS RD DEPT OF
FALLS CHURCH VA
22042-3300
US

IV. Provider business mailing address

2150 PENNSYLVANIA AVE NW
WASHINGTON DC
20037-3201
US

V. Phone/Fax

Practice location:
  • Phone: 703-776-3626
  • Fax:
Mailing address:
  • Phone: 202-741-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License Number0116036020
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number0116036020
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: