Healthcare Provider Details

I. General information

NPI: 1922530294
Provider Name (Legal Business Name): MEDIA ISMAEL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2017
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 E LEIGH ST
RICHMOND VA
23298-5004
US

IV. Provider business mailing address

1200 E BROAD ST FL 14
RICHMOND VA
23298-5025
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-2467
  • Fax: 804-828-5348
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0008X
TaxonomyHepatology Physician
License Number0101285159
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME164306
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: