Healthcare Provider Details

I. General information

NPI: 1346353539
Provider Name (Legal Business Name): AMR ALY ELSAADAT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: AMR ALY ABOU ELSAADAT M.B. CH.B.

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 J CLYDE MORRIS BLVD
NEWPORT NEWS VA
23601-1929
US

IV. Provider business mailing address

3998 FAIR RIDGE DR SUITE 300
FAIRFAX VA
22033-2907
US

V. Phone/Fax

Practice location:
  • Phone: 757-594-2000
  • Fax: 757-826-9028
Mailing address:
  • Phone: 703-766-9737
  • Fax: 703-766-9725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number01010251223
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number0101251223
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: