Healthcare Provider Details

I. General information

NPI: 1376063826
Provider Name (Legal Business Name): OMER FAROOQ BANGASH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2017
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E BROAD ST FL 6
RICHMOND VA
23219-1930
US

IV. Provider business mailing address

PO BOX 980257
RICHMOND VA
23298-0257
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-2467
  • Fax: 804-441-7130
Mailing address:
  • Phone: 804-828-2467
  • Fax: 804-441-7130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number0101267885
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: