Healthcare Provider Details

I. General information

NPI: 1710933320
Provider Name (Legal Business Name): KAMRUL I KASHEM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 10/02/2020
Certification Date: 09/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 SUNSET LN
CULPEPER VA
22701-3917
US

IV. Provider business mailing address

P.O. BOX 414768 LOCK BOX
BOSTON MA
02241-4768
US

V. Phone/Fax

Practice location:
  • Phone: 540-829-4100
  • Fax:
Mailing address:
  • Phone: 781-937-4556
  • Fax: 781-937-6455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number0101239369
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: