Basic Information
Provider Information
NPI: 1164742359
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ABOUZAKI
FirstName: NAYEF
MiddleName: ANTAR
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 91734
Address2:  
City: RICHMOND
State: VA
PostalCode: 232911734
CountryCode: US
TelephoneNumber: 8043586100
FaxNumber: 8043427619
Practice Location
Address1: 417 N 11TH ST
Address2:  
City: RICHMOND
State: VA
PostalCode: 232985002
CountryCode: US
TelephoneNumber: 8046284327
FaxNumber: 8048284670
Other Information
ProviderEnumerationDate: 06/10/2010
LastUpdateDate: 03/17/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RI0011X0101251528VAY Allopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology

No ID Information.


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