Provider Demographics
NPI:1891836128
Name:OBESITY SURGERY CENTER INC
Entity Type:Organization
Organization Name:OBESITY SURGERY CENTER INC
Other - Org Name:OSVALDO ANEZ MD FACS
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OSVALDO
Authorized Official - Middle Name:
Authorized Official - Last Name:ANEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD FACS
Authorized Official - Phone:703-860-8101
Mailing Address - Street 1:6035 BURKE CENTRE PKWY
Mailing Address - Street 2:#390
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-3750
Mailing Address - Country:US
Mailing Address - Phone:703-978-1196
Mailing Address - Fax:703-978-7762
Practice Address - Street 1:462 HERNDON PKWY
Practice Address - Street 2:#101
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-5233
Practice Address - Country:US
Practice Address - Phone:703-956-6743
Practice Address - Fax:703-956-6749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101035038208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty