Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 0101057789 | VA |
NPI | 1043203557 |
---|---|
Provider Name | Dr. Sameera Nasser Rentia |
First Address | Falls Church, VA 22041-2867 |
Second Address | Falls Church, VA 22041-2867 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2005 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
245309 | BC/BS VA (01) | VA |
487964 | NCPPO (01) | VA |
5947752 | AETNA (01) | VA |
6734928 | (05) | VA |
899686 | MAMSI (01) | VA |
F6790001 | BC/BS DC (01) | DC |