Healthcare Provider Details

I. General information

NPI: 1225088560
Provider Name (Legal Business Name): MUNEERA ASAD MAHMOOD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 BROAD ROCK BLVD MCGUIRE VA MEDICAL CENTER , EYE CLINIC (112)
RICHMOND VA
23249-0001
US

IV. Provider business mailing address

10056 OAKLEY CT
VIENNA VA
22181-5354
US

V. Phone/Fax

Practice location:
  • Phone: 804-675-5541
  • Fax: 804-675-5908
Mailing address:
  • Phone: 804-675-5000
  • Fax: 804-675-5908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number0101048777
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD32958
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: