Provider Demographics
NPI:1235156084
Name:ORAEE, SAMAD (MD)
Entity Type:Individual
Prefix:
First Name:SAMAD
Middle Name:
Last Name:ORAEE
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 1:2050 OLD BRIDGE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-2481
Mailing Address - Country:US
Mailing Address - Phone:703-492-7626
Mailing Address - Fax:703-492-7537
Practice Address - Street 1:2050 OLD BRIDGE RD
Practice Address - Street 2:STE 200
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-2481
Practice Address - Country:US
Practice Address - Phone:703-491-5367
Practice Address - Fax:703-492-7537
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101049783208VP0000X
VA01010497892084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006102522Medicaid
VA130012390OtherRAILROAD MEDICARE
130000504Medicare PIN
F61774Medicare UPIN
VA006102522Medicaid