Provider Demographics
NPI:1346353539
Name:ELSAADAT, AMR ALY (MD)
Entity Type:Individual
Prefix:DR
First Name:AMR
Middle Name:ALY
Last Name:ELSAADAT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:AMR
Other - Middle Name:ALY
Other - Last Name:ABOU ELSAADAT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MB CHB
Mailing Address - Street 1:3998 FAIR RIDGE DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-2907
Mailing Address - Country:US
Mailing Address - Phone:703-766-9737
Mailing Address - Fax:703-766-9725
Practice Address - Street 1:500 J CLYDE MORRIS BLVD
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23601-1929
Practice Address - Country:US
Practice Address - Phone:757-594-2000
Practice Address - Fax:757-826-9028
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010251223207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1346353539Medicaid
VA238588YRNMedicare PIN