MEDICARE: KHALED A MOUSTAFA MD, FAAFP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	0101243031	VA
2	207Q00000X	Family Medicine Physician	4301080126	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
7	273479074	OTHER	VA	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1598712390	OTHER	MI	GROUP NPI
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	0804115242	OTHER	MI	BCBS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891746061
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KHALED A MOUSTAFA MD, FAAFP

Provider Business Mailing Address
First Line	:	1770 N PARHAM RD
Second Line	:	100
City	:	RICHMOND
State	:	VA
Zip	:	23229-4658
Country	:	US
Telephone Number	:	804-615-5060
Fax Number	:	804-364-3520

Provider Business Practice Location Address
First Line	:	1770N PARHAM RD 100
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23229-4658
Country	:	US
Telephone Number	:	804-615-5060
Fax Number	:	804-364-3520

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/13/2006
Last Update Date	:	09/28/2015

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