Healthcare Provider Details

I. General information

NPI: 1447166046
Provider Name (Legal Business Name): OBADA KHAYYAT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2026
Last Update Date: 08/22/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 ELECTRIC RD
SALEM VA
24153-7494
US

IV. Provider business mailing address

12731 JUSTIN TRL
HOUSTON TX
77070-4663
US

V. Phone/Fax

Practice location:
  • Phone: 540-776-4000
  • Fax:
Mailing address:
  • Phone: 281-925-9075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: