Healthcare Provider Details

I. General information

NPI: 1649351164
Provider Name (Legal Business Name): MOHAMMAD KHALID IQBAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 08/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2221 WEST CUMBERLAND RD
BLUEFIELD VA
24605
US

IV. Provider business mailing address

PO BOX 1347
BLUEFIELD VA
24605
US

V. Phone/Fax

Practice location:
  • Phone: 276-322-3180
  • Fax: 276-322-1308
Mailing address:
  • Phone: 276-322-3180
  • Fax: 276-322-1308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101048107
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number0101048107
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: