Healthcare Provider Details

I. General information

NPI: 1477799286
Provider Name (Legal Business Name): PEDIATRIC LUNG, ALLERGY AND SLEEP SPECIALISTS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2008
Last Update Date: 12/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 HIOAKS RD SUITE F
RICHMOND VA
23225-4038
US

IV. Provider business mailing address

909 HIOAKS RD SUITE F
RICHMOND VA
23225-4038
US

V. Phone/Fax

Practice location:
  • Phone: 804-464-2271
  • Fax:
Mailing address:
  • Phone: 804-464-2271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number0101240720
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2080S0012X
TaxonomyPediatric Sleep Medicine Physician
License Number0101240720
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number0101240720
License Number StateVA

VIII. Authorized Official

Name: DR. MUHAMMAD RAIS
Title or Position: PRESIDENT
Credential: MD
Phone: 804-464-2271