Healthcare Provider Details

I. General information

NPI: 1437647807
Provider Name (Legal Business Name): NIMA VAHIDI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2018
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 E BROAD ST
RICHMOND VA
23298-5025
US

IV. Provider business mailing address

1200 E BROAD ST
RICHMOND VA
23298-5025
US

V. Phone/Fax

Practice location:
  • Phone: 804-628-4368
  • Fax:
Mailing address:
  • Phone: 804-628-4368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number322296
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number0101282485
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: