Healthcare Provider Details

I. General information

NPI: 1326175043
Provider Name (Legal Business Name): HAMPTON ROADS FAMILY PRACTICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 12/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

665 NEWTOWN RD STE 114
VIRGINIA BEACH VA
23462-1683
US

IV. Provider business mailing address

665 NEWTOWN RD STE 114
VIRGINIA BEACH VA
23462-1683
US

V. Phone/Fax

Practice location:
  • Phone: 757-490-1226
  • Fax:
Mailing address:
  • Phone: 757-490-1226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101038190
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number0103300868
License Number StateVA

VIII. Authorized Official

Name: DR. MOHAMMAD RASSOOL
Title or Position: PHYSICIAN
Credential: MD
Phone: 757-490-1226