Healthcare Provider Details

I. General information

NPI: 1720293285
Provider Name (Legal Business Name): MOHAMMED BADIUL ALAM BHUIYAN MD., MPH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 07/11/2025
Certification Date: 07/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 BROAD ROCK BLVD # D
RICHMOND VA
23249-1553
US

IV. Provider business mailing address

1201 BROAD ROCK BLVD # D
RICHMOND VA
23249-1553
US

V. Phone/Fax

Practice location:
  • Phone: 804-675-5455
  • Fax: 804-675-5223
Mailing address:
  • Phone: 804-675-5455
  • Fax: 48-675-5223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101238424
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code2081P0004X
TaxonomySpinal Cord Injury Medicine Physician
License Number0101238424
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: