Provider Demographics
NPI:1023179769
Name:ATIYEH, BASSAM A (MD)
Entity Type:Individual
Prefix:DR
First Name:BASSAM
Middle Name:A
Last Name:ATIYEH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 N VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22046-3336
Mailing Address - Country:US
Mailing Address - Phone:703-532-4446
Mailing Address - Fax:703-532-8426
Practice Address - Street 1:107 N VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046-3336
Practice Address - Country:US
Practice Address - Phone:703-532-4446
Practice Address - Fax:703-532-8426
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101053250208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics