Healthcare Provider Details

I. General information

NPI: 1346565967
Provider Name (Legal Business Name): SAMAD ORAEE, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2010
Last Update Date: 01/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 OLD BRIDGE RD SUITE 200
WOODBRIDGE VA
22192-2481
US

IV. Provider business mailing address

2050 OLD BRIDGE RD SUITE 200
WOODBRIDGE VA
22192-2481
US

V. Phone/Fax

Practice location:
  • Phone: 703-492-7626
  • Fax: 703-492-7537
Mailing address:
  • Phone: 703-492-7626
  • Fax: 703-492-7537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number0101049783
License Number StateVA

VIII. Authorized Official

Name: SAMAD ORAEE
Title or Position: PRACTICE OWNER
Credential: M.D.
Phone: 703-492-7626