MEDICARE: ISSAM KHAYATA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	0101259392	VA
2	207L00000X	Anesthesiology Physician	212629	MA
3	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	0101259392	VA
4	207LP2900X	Pain Medicine (Anesthesiology) Physician	0101259392	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174576581
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ISSAM KHAYATA MD

Provider Business Mailing Address
First Line	:	PO BOX 2521
Second Line	:
City	:	RESTON
State	:	VA
Zip	:	20195-0521
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	20 PIDGEON HILL DR
Second Line	:	STE 205
City	:	STERLING
State	:	VA
Zip	:	20165-6134
Country	:	US
Telephone Number	:	508-334-3271
Fax Number	:	508-856-5911

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	11/22/2024

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Directions to “ ISSAM KHAYATA MD” Practice Location

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