Provider Demographics
NPI:1043243728
Name:DALLAS, OLYMPIA P (MD)
Entity Type:Individual
Prefix:DR
First Name:OLYMPIA
Middle Name:P
Last Name:DALLAS
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 1:4400 UNIVERSITY DR
Mailing Address - Street 2:MS 2D3 GEORGE MASON UNIVERSITY STUDENT HEALTH
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030
Mailing Address - Country:US
Mailing Address - Phone:703-993-2807
Mailing Address - Fax:703-993-4365
Practice Address - Street 1:4400 UNIVERSITY DR
Practice Address - Street 2:MS 2D3 GEORGE MASON UNIVERSITY STUDENT HEALTH
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030
Practice Address - Country:US
Practice Address - Phone:703-993-2807
Practice Address - Fax:703-993-4365
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101033600174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0101033600OtherMEDICAL LICENSE
AD2008313OtherDEA
00A523A55Medicare ID - Type UnspecifiedINDIVIDUAL PROVIDER NUMBE
AD2008313OtherDEA