Provider Demographics
NPI:1114503018
Name:MOMAND, OMAID
Entity Type:Individual
Prefix:
First Name:OMAID
Middle Name:
Last Name:MOMAND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14703 TRUITT FARM DR
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20120-5411
Mailing Address - Country:US
Mailing Address - Phone:202-840-1251
Mailing Address - Fax:
Practice Address - Street 1:14703 TRUITT FARM DR
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20120-5411
Practice Address - Country:US
Practice Address - Phone:202-840-1251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-22
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VARBT-20-142570106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician