Healthcare Provider Details

I. General information

NPI: 1689247686
Provider Name (Legal Business Name): SYED HASHIM ALI INAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2021
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3920 BRIDGE RD STE 204
SUFFOLK VA
23435-1107
US

IV. Provider business mailing address

3920 BRIDGE RD STE 204
SUFFOLK VA
23435-1107
US

V. Phone/Fax

Practice location:
  • Phone: 757-683-0351
  • Fax: 757-510-9041
Mailing address:
  • Phone: 757-683-0351
  • Fax: 757-510-9041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number0101286962
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: