=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003867433
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WALID G. ABOU ASSI M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/12/2006
-----------------------------------------------------
Last Update Date | 08/31/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7605 FOREST AVE SUITE 109
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23229-4938
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-285-6390
-----------------------------------------------------
Fax | 804-285-6393
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1603 SANTA ROSA RD RM 102
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23229-5010
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-288-6750
-----------------------------------------------------
Fax | 804-288-6753
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RN0300X
-----------------------------------------------------
Taxonomy Name | Nephrology Physician
-----------------------------------------------------
License Number | 0101245252
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------