Individual
ISSAM KHAYATA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
20 PIDGEON HILL DR, STE 205, STERLING, VA 20165-6134
(508) 334-3271
(508) 856-5911
Mailing address
PO BOX 2521, RESTON, VA 20195-0521
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
0101259392
VA
207L00000X
Anesthesiology Physician
212629
MA
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
0101259392
VA
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
0101259392
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0179043
—
MA
05
—
30015831410003
—
VA
Enumeration date
05/18/2006
Last updated
11/22/2024
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