Healthcare Provider Details

I. General information

NPI: 1982622825
Provider Name (Legal Business Name): IBRAHIM MOHAMED HEGAB MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 02/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7660 E PARHAM RD STE 208
RICHMOND VA
23294-4378
US

IV. Provider business mailing address

PO BOX 71078
RICHMOND VA
23255-1078
US

V. Phone/Fax

Practice location:
  • Phone: 804-353-0023
  • Fax: 804-353-0073
Mailing address:
  • Phone: 804-353-0023
  • Fax: 804-353-0773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number0101240307
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: