Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 0101049497 | VA |
NPI | 1093765646 |
---|---|
Provider Name | Hussien A Al-Shammaa |
First Address | Farmville, VA 23901-1510 |
Second Address | Farmville, VA 23901-1510 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2006 |
Last Update Date | 03/10/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
006705278 | (05) | VA |
F81651 | (02) | VA |