Healthcare Provider Details

I. General information

NPI: 1194921783
Provider Name (Legal Business Name): TARIQ IQBAL M.D.,
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2007
Last Update Date: 12/20/2021
Certification Date: 12/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 KEMPSVILLE RD STE 100F
NORFOLK VA
23502-3920
US

IV. Provider business mailing address

850 KEMPSVILLE RD STE 100F
NORFOLK VA
23502-3920
US

V. Phone/Fax

Practice location:
  • Phone: 757-261-5910
  • Fax: 757-275-9940
Mailing address:
  • Phone: 757-261-5910
  • Fax: 757-275-9940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number0101243561
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: