Provider Demographics
NPI:1811152242
Name:ESAM S. OMEISH, MD, PC
Entity type:Organization
Organization Name:ESAM S. OMEISH, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ESAM
Authorized Official - Middle Name:
Authorized Official - Last Name:OMEISH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-360-9700
Mailing Address - Street 1:PO BOX 8325
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22041-8325
Mailing Address - Country:US
Mailing Address - Phone:703-360-9700
Mailing Address - Fax:703-780-9229
Practice Address - Street 1:2849 DUKE ST
Practice Address - Street 2:SUITE 14
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-4512
Practice Address - Country:US
Practice Address - Phone:703-360-9700
Practice Address - Fax:703-780-9229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-24
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101057717208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty