Provider Demographics
NPI:1255310405
Name:RO, OHSANG NMI (MD)
Entity Type:Individual
Prefix:DR
First Name:OHSANG
Middle Name:NMI
Last Name:RO
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 1:7008 LITTLE RIVER TPKE STE A
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-3234
Mailing Address - Country:US
Mailing Address - Phone:703-333-2922
Mailing Address - Fax:
Practice Address - Street 1:7008 LITTLE RIVER TPKE STE A
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-3234
Practice Address - Country:US
Practice Address - Phone:703-333-2922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-14
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35043280207Q00000X
VA0101244392207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0416535Medicaid
OHA78506Medicare UPIN
OHRO0462012Medicare ID - Type Unspecified