Healthcare Provider Details

I. General information

NPI: 1780976704
Provider Name (Legal Business Name): MIHRAN OZBALIK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2011
Last Update Date: 06/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 E MARSHALL ST NEURO: ADULT
RICHMOND VA
23298-5051
US

IV. Provider business mailing address

PO BOX 980599 NEURO: ADULT
RICHMOND VA
23298-0599
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-9350
  • Fax: 804-828-8965
Mailing address:
  • Phone: 804-828-9350
  • Fax: 804-828-8965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: