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General NPI Number Information
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NPI Number | 1487170841
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Entity Type | Organization
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Legal Business Name | BLUEFIELD PEDIATRIC CARDIOLOGY ASSOCIATES
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Dates
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Enumeration Date | 08/17/2017
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Last Update Date | 08/17/2017
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Provider Practice Location Address
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Address Line | 2221 W CUMBERLAND RD
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City | BLUEFIELD
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State | VA
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Zip | 24605
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Country | US
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Telephone | 276-322-7043
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Fax | 276-322-7064
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Provider Business Mailing Address
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Address Line | 2221 W CUMBERLAND RD
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City | BLUEFIELD
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State | VA
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Zip | 24605
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Country | US
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Telephone | 276-322-7043
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Fax | 276-322-7064
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Authorized Official
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Title or Position | PEDIATRIC CARDIOLOGIST
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Name | MR. MOHAMMAD KHALID IQBAL
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Credential | MD
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Telephone | 276-322-7064
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0202X
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Taxonomy Name | Pediatric Cardiology Physician
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License Number | 0101048107
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License Number State | VA
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