Provider Demographics
NPI:1043203557
Name:RENTIA, SAMEERA NASSER (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMEERA
Middle Name:NASSER
Last Name:RENTIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5651 COLUMBIA PIKE
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22041-2867
Mailing Address - Country:US
Mailing Address - Phone:703-933-0740
Mailing Address - Fax:703-933-0744
Practice Address - Street 1:5651 COLUMBIA PIKE
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22041-2867
Practice Address - Country:US
Practice Address - Phone:703-933-0740
Practice Address - Fax:703-933-0744
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-30
Last Update Date:2007-07-09
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-03-30
Provider Licenses
StateLicense IDTaxonomies
VA01010577892080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA899686OtherMAMSI
VA245309OtherBC/BS VA
DCF6790001OtherBC/BS DC
VA487964OtherNCPPO
VA6734928Medicaid
VA5947752OtherAETNA