Healthcare Provider Details

I. General information

NPI: 1821016288
Provider Name (Legal Business Name): REZA KHAN OMARZAI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 07/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 PUDDLEDOCK RD 400
PRINCE GEORGE VA
23875-1268
US

IV. Provider business mailing address

8001 FRANKLIN FARMS DR SUITE 130
RICHMOND VA
23229-5108
US

V. Phone/Fax

Practice location:
  • Phone: 804-458-1740
  • Fax: 804-541-1846
Mailing address:
  • Phone: 804-521-5800
  • Fax: 804-545-4340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number0101057678
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: