Healthcare Provider Details

I. General information

NPI: 1760864003
Provider Name (Legal Business Name): MOHAMMED S ABDULGHANI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2015
Last Update Date: 06/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

618 HOSPITAL RD
TAPPAHANNOCK VA
22560
US

IV. Provider business mailing address

856 J CLYDE MORRIS BLVD STE A
NEWPORT NEWS VA
23601-1318
US

V. Phone/Fax

Practice location:
  • Phone: 804-443-3311
  • Fax: 804-443-6150
Mailing address:
  • Phone: 757-316-5800
  • Fax: 757-534-5190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number0101264263
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: