=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366238610
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HISHAM MOHAMMED BABU M.B.B.S.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/15/2025
-----------------------------------------------------
Last Update Date | 09/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 825 FAIRFAX AVE, P.O. BOX 1980 INTERNAL MEDICINE, HOFHEIMER HALL- 5TH FLOOR
-----------------------------------------------------
City | NORFOLK
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-446-5258
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | MACON & JOAN BROCK VHS AT OLD DOMINION UNIVERSITY -EVMS P.O. BOX 1980, GRADUATE MEDICAL EDUCATION
-----------------------------------------------------
City | NORFOLK
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-446-5258
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------