Healthcare Provider Details

I. General information

NPI: 1447216668
Provider Name (Legal Business Name): REHAN SALEEM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 05/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14410 SOMMERVILLE CT SUITE 101
MIDLOTHIAN VA
23113-6835
US

IV. Provider business mailing address

14410 SOMMERVILLE CT SUITE 101
MIDLOTHIAN VA
23113-6835
US

V. Phone/Fax

Practice location:
  • Phone: 804-897-9355
  • Fax: 804-897-9359
Mailing address:
  • Phone: 804-897-9355
  • Fax: 804-897-9359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101236073
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number0101236073
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: