Healthcare Provider Details

I. General information

NPI: 1912213141
Provider Name (Legal Business Name): VISHAL ABHILASH VASAVADA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2010
Last Update Date: 07/05/2024
Certification Date: 07/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 GRESHAM DR FL 5
NORFOLK VA
23507-1904
US

IV. Provider business mailing address

600 GRESHAM DR FL 5
NORFOLK VA
23507-1904
US

V. Phone/Fax

Practice location:
  • Phone: 577-388-4242
  • Fax:
Mailing address:
  • Phone: 577-388-4242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101254148
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: