Healthcare Provider Details

I. General information

NPI: 1043203557
Provider Name (Legal Business Name): SAMEERA NASSER RENTIA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date: 03/23/2006
Reactivation Date: 03/30/2006

III. Provider practice location address

5651 COLUMBIA PIKE
FALLS CHURCH VA
22041-2867
US

IV. Provider business mailing address

5651 COLUMBIA PIKE
FALLS CHURCH VA
22041-2867
US

V. Phone/Fax

Practice location:
  • Phone: 703-933-0740
  • Fax: 703-933-0744
Mailing address:
  • Phone: 703-933-0740
  • Fax: 703-933-0744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number0101057789
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: