Basic Information
| Provider Information | |||||||||
| NPI: | 1023004710 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ABOU ASSI | ||||||||
| FirstName: | SOUHEIL | ||||||||
| MiddleName: | GHANDOUR | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2369 STAPLES MILL RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232302918 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8042854465 | ||||||||
| FaxNumber: | 8042858332 | ||||||||
| Practice Location | |||||||||
| Address1: | 6602 W BROAD ST STE B | ||||||||
| Address2: | |||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232301702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8042858206 | ||||||||
| FaxNumber: | 8042886602 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2005 | ||||||||
| LastUpdateDate: | 01/29/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 0101058695 | VA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 1100088459 | 05 | VA | MEDICAID |