Basic Information
| Provider Information | |||||||||
| NPI: | 1235559394 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHAIRZAY | ||||||||
| FirstName: | OMAR | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 13306 | ||||||||
| Address2: | |||||||||
| City: | ROANOKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 240323306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5403450289 | ||||||||
| FaxNumber: | 5403459569 | ||||||||
| Practice Location | |||||||||
| Address1: | 3800 RESERVOIR ROAD, NW | ||||||||
| Address2: | LL CCC BUILDING, SUITE CL-60 | ||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 20007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2024448640 | ||||||||
| FaxNumber: | 2024448854 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/16/2014 | ||||||||
| LastUpdateDate: | 07/23/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207L00000X | 0101263811 | VA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.