Healthcare Provider Details

I. General information

NPI: 1124316211
Provider Name (Legal Business Name): USAMA SAMAAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2011
Last Update Date: 07/30/2022
Certification Date: 07/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1770 N PARHAM RD STE 100
RICHMOND VA
23229-4658
US

IV. Provider business mailing address

1770 N PARHAM RD STE 100
RICHMOND VA
23229-4658
US

V. Phone/Fax

Practice location:
  • Phone: 804-665-5457
  • Fax:
Mailing address:
  • Phone: 804-665-5457
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01011255804
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: