Healthcare Provider Details

I. General information

NPI: 1891836128
Provider Name (Legal Business Name): OBESITY SURGERY CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 01/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

462 HERNDON PKWY #101
HERNDON VA
20170-5233
US

IV. Provider business mailing address

6035 BURKE CENTRE PKWY #390
BURKE VA
22015-3750
US

V. Phone/Fax

Practice location:
  • Phone: 703-956-6743
  • Fax: 703-956-6749
Mailing address:
  • Phone: 703-978-1196
  • Fax: 703-978-7762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0101035038
License Number StateVA

VIII. Authorized Official

Name: DR. OSVALDO ANEZ
Title or Position: PRESIDENT
Credential: MD FACS
Phone: 703-860-8101