Healthcare Provider Details

I. General information

NPI: 1144581661
Provider Name (Legal Business Name): KEVON M HEKMATDOOST M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2012
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5855 BREMO RD STE 207
RICHMOND VA
23226-1922
US

IV. Provider business mailing address

5855 BREMO RD STE 207
RICHMOND VA
23226-1922
US

V. Phone/Fax

Practice location:
  • Phone: 985-264-6487
  • Fax:
Mailing address:
  • Phone: 985-264-6487
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number0101262243
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number50268
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: