1518949791 NPI number — GEORGE JOSEPH MEHFOUD M.D.

Table of content: GEORGE JOSEPH MEHFOUD M.D. (NPI 1518949791)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518949791 NPI number — GEORGE JOSEPH MEHFOUD M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MEHFOUD
Provider First Name:
GEORGE
Provider Middle Name:
JOSEPH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1518949791
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/20/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1800 GLENSIDE DR
Provider Second Line Business Mailing Address:
SUITE 105
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23226-3769
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-288-0399
Provider Business Mailing Address Fax Number:
804-285-0088

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8923 THREE CHOPT RD
Provider Second Line Business Practice Location Address:
STE 101
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23229-4660
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-288-0057
Provider Business Practice Location Address Fax Number:
804-288-0389
Provider Enumeration Date:
11/15/2005

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: 207Q00000X , with the licence number:  0101046156 , 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: 006085482 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1518949791 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110056020 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 141501 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 141506 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 302011 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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