Healthcare Provider Details

I. General information

NPI: 1295194983
Provider Name (Legal Business Name): VMG SPECIALISTS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2016
Last Update Date: 04/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 OLD WAGNER RD SUITE 102
PETERSBURG VA
23805-9313
US

IV. Provider business mailing address

601 OLD WAGNER RD SUITE 102
PETERSBURG VA
23805-9313
US

V. Phone/Fax

Practice location:
  • Phone: 804-524-2260
  • Fax: 804-524-0096
Mailing address:
  • Phone: 804-524-2260
  • Fax: 804-524-0096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: TAHIR ALLAUDDIN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 804-524-2260