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General NPI Number Information
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NPI Number | 1073793055
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Entity Type | Organization
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Legal Business Name | UZMA EHTESHAM MD PLLC
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Dates
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Enumeration Date | 11/07/2007
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Last Update Date | 02/01/2010
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Provider Practice Location Address
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Address Line | 611 TRENT ST NE
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City | NORTON
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State | VA
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Zip | 24273-1533
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Country | US
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Telephone | 276-679-4200
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Fax | 276-679-4230
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Provider Business Mailing Address
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Address Line | PO BOX 386
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City | WISE
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State | VA
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Zip | 24293-0386
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Country | US
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Telephone | 276-679-4200
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Fax | 276-679-4230
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. UZMA EHTESHAM
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Credential | M.D.
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Telephone | 276-679-4200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 0101235302
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License Number State | VA
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