Healthcare Provider Details

I. General information

NPI: 1932951530
Provider Name (Legal Business Name): HISHAM ISHTYAQ QADRI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2024
Last Update Date: 06/22/2025
Certification Date: 06/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 E MARSHALL ST
RICHMOND VA
23298-5023
US

IV. Provider business mailing address

GME ADMIN 1200 EAST BROAD STREET, BOX 980257
RICHMOND VA
23298
US

V. Phone/Fax

Practice location:
  • Phone: 804-628-7497
  • Fax: 804-827-1016
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0116039172
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: