Healthcare Provider Details

I. General information

NPI: 1801992144
Provider Name (Legal Business Name): TRISSANA D EMDADI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TRISSANA L DEMLOW MD

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 06/16/2021
Certification Date: 06/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2304 W MERCURY BLVD
HAMPTON VA
23666-3115
US

IV. Provider business mailing address

5000 COX RD
GLEN ALLEN VA
23060-9263
US

V. Phone/Fax

Practice location:
  • Phone: 757-951-1579
  • Fax: 757-951-1580
Mailing address:
  • Phone: 804-968-5700
  • Fax: 804-217-7991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101240572
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: