Healthcare Provider Details

I. General information

NPI: 1174151260
Provider Name (Legal Business Name): MUHAMMAD TALHA AMJAD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2020
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5716 CLEVELAND ST STE 200
VIRGINIA BEACH VA
23462-1784
US

IV. Provider business mailing address

20100 WALKER RD UNIT 423
SHAKER HEIGHTS OH
44122-3663
US

V. Phone/Fax

Practice location:
  • Phone: 757-490-4802
  • Fax:
Mailing address:
  • Phone: 571-344-4523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number34.016922
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number0102209102
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberOL61375097
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: