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General NPI Number Information
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NPI Number | 1063155968
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Entity Type | Individual
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Provider Name | MOSTAFA GAMAL HUSSIEN AB ELRAZZAZ
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Gender | Male
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Dates
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Enumeration Date | 04/18/2022
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Last Update Date | 10/06/2025
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Provider Practice Location Address
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Address Line | 142 S MAIN ST
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City | DANVILLE
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State | VA
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Zip | 24541-2922
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Country | US
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Telephone | 434-799-2225
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Fax |
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Provider Business Mailing Address
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Address Line | 1140 PREMIER KEY DR
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City | CARY
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State | NC
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Zip | 27513-5372
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Country | US
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Telephone | 502-389-8568
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 0101284055
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License Number State | VA
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