Provider Demographics
NPI:1124316211
Name:SAMAAN, USAMA (MD)
Entity type:Individual
Prefix:
First Name:USAMA
Middle Name:
Last Name:SAMAAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1770 N PARHAM RD STE 100
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23229-4658
Mailing Address - Country:US
Mailing Address - Phone:804-665-5457
Mailing Address - Fax:
Practice Address - Street 1:1770 N PARHAM RD STE 100
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-4658
Practice Address - Country:US
Practice Address - Phone:804-665-5457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-11
Last Update Date:2022-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01011255804208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA3001743747001Medicaid