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NPI Code Detail

MEDICARE: MEDIKO, PC

MEDICARE: MEDIKO, PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0800XPsychiatry PhysicianVA

General Provider Information

NPI Number : 1659658805
Entity Type Code : Organization
Provider Name (Legal Business Name) : MEDIKO, PC
Provider Business Mailing Address
First Line : 301 CONCOURSE BLVD
Second Line : SUITE 210
City : GLEN ALLEN
State : VA
Zip : 23059-5643
Country : US
Telephone Number : 804-433-1010
Fax Number : 804-433-1055
Provider Business Practice Location Address
First Line : 301 CONCOURSE BLVD
Second Line : SUITE 210
City : GLEN ALLEN
State : VA
Zip : 23059-5643
Country : US
Telephone Number : 804-433-1010
Fax Number : 804-433-1055
Authorized Official
Title or Position : PRESIDENT
Name : DR. KAVEH OFOGH
Credential : M.D.
Telephone Number : 804-433-1040
Provider Enumeration Date : 11/15/2011
Last Update Date : 11/15/2011

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Directions to “MEDIKO, PC ” Practice Location

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