Healthcare Provider Details

I. General information

NPI: 1033188354
Provider Name (Legal Business Name): PAUL A GHAEMMAGHAMI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 02/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5855 BREMO RD SUITE 101
RICHMOND VA
23226-1930
US

IV. Provider business mailing address

5855 BREMO RD SUITE 101
RICHMOND VA
23226-1930
US

V. Phone/Fax

Practice location:
  • Phone: 804-673-0080
  • Fax: 804-285-2637
Mailing address:
  • Phone: 804-673-0080
  • Fax: 804-285-2637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number0101221475
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: