1033105408 NPI number — AGHA W HAIDER MD PHD

Table of content: AGHA W HAIDER MD PHD (NPI 1033105408)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033105408 NPI number — AGHA W HAIDER MD PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAIDER
Provider First Name:
AGHA
Provider Middle Name:
W
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD PHD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033105408
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/26/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
909 HIOAKS RD
Provider Second Line Business Mailing Address:
SUITE E
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23225-4038
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-269-5112
Provider Business Mailing Address Fax Number:
877-795-7329

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
909 HIOAKS RD
Provider Second Line Business Practice Location Address:
SUITE E
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23225-4038
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-269-5112
Provider Business Practice Location Address Fax Number:
877-795-7329
Provider Enumeration Date:
09/21/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  MD419248 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X , with the licence number: 0101247463 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1013280500001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: VAA102350 . This is a "MEDICARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1033105408 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00863900 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com