Provider Demographics
NPI:1477650281
Name:OMALIA, MARISSA R (DC)
Entity Type:Individual
Prefix:DR
First Name:MARISSA
Middle Name:R
Last Name:OMALIA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2440 M STREET NW
Mailing Address - Street 2:SUITE 807
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20037
Mailing Address - Country:US
Mailing Address - Phone:202-887-5375
Mailing Address - Fax:202-887-1833
Practice Address - Street 1:2440 M STREET NW
Practice Address - Street 2:SUITE 807
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037
Practice Address - Country:US
Practice Address - Phone:202-887-5375
Practice Address - Fax:202-887-1833
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC21161111N00000X
VA111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC2141130OtherMAMSI
DC2141130OtherMAMSI
U66944Medicare UPIN