Provider Demographics
NPI:1093765646
Name:AL-SHAMMAA, HUSSIEN A (M D,FAAP)
Entity Type:Individual
Prefix:
First Name:HUSSIEN
Middle Name:A
Last Name:AL-SHAMMAA
Suffix:
Gender:M
Credentials:M D,FAAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3350 COMMISSION CT
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-1784
Mailing Address - Country:US
Mailing Address - Phone:703-680-7950
Mailing Address - Fax:
Practice Address - Street 1:9705 LIBERIA AVE
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-1743
Practice Address - Country:US
Practice Address - Phone:703-680-7950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101049497208000000X, 2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006705278Medicaid
VA006705278Medicaid