Old Town Manassas Medical Center

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

0663198-0 Issued in VA

Legal business name

OLD TOWN MANASSAS MEDICAL CENTER

Practice address

9003 Church St
Manassas, VA 20110-5410

Phone

(703) 365-0397

Fax

(703) 365-0399

NPI assigned

Oct 3, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Flaviano Dazo, D.N.P., FNP-BC

Title

Owner

Phone

(703) 365-0397

Specialties & licenses 1

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Pierre Mawesa Diomi Jr., MD

  • Family Medicine Physician
  • Manassas, VA
  • NPI 1619521051
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1412294400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1412294400000",
    "number": "1184027161",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9003 CHURCH ST",
            "city": "MANASSAS",
            "state": "VA",
            "postal_code": "201105410",
            "telephone_number": "703-365-0397",
            "fax_number": "703-365-0399"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9003 CHURCH ST",
            "city": "MANASSAS",
            "state": "VA",
            "postal_code": "201105410",
            "telephone_number": "703-365-0397",
            "fax_number": "703-365-0399"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OLD TOWN MANASSAS MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-03",
        "last_updated": "2014-10-03",
        "status": "A",
        "authorized_official_last_name": "DAZO",
        "authorized_official_first_name": "FLAVIANO",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "703-365-0397",
        "authorized_official_credential": "D.N.P., FNP-BC"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "VA",
            "license": "0663198-0",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Minuja Ojha, DMD
• Henrietta Okyere
• Roselyn Okyere
• Abimbola Faridah Olabiyi, MD
• Old Dominion Orthopaedics and Sports Medicine, PC (Northern Virginia Orthopaedic Specialist)
• Ole Optical Laboratory Express LLC
• Gabrielle Olivier, MS, CCC-SLP
• Omega Health Services
• Sana Omer
• Iyabode Onamuti

• Clinic/Center in Manassas, VA
• Providers in Manassas, VA by specialty
• Clinic/Center in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.