Organization
DULLES PAIN & FUNCTIONAL MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ISSAM KHAYATA MD (OWNER)
(703) 884-8400
Entity
Organization
Contact information
Practice address
20 PIDGEON HILL DR STE 205, STERLING, VA 20165-6134
(703) 884-8400
Mailing address
PO BOX 2521, RESTON, VA 20195-0521
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
—
—
207LC0200X
Critical Care Medicine (Anesthesiology) Physician
—
—
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
—
—
Other
Enumeration date
09/16/2020
Last updated
10/14/2020
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