Provider Demographics
NPI:1144581661
Name:HEKMATDOOST, KEVON M (MD)
Entity Type:Individual
Prefix:
First Name:KEVON
Middle Name:M
Last Name:HEKMATDOOST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5855 BREMO RD STE 207
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-1922
Mailing Address - Country:US
Mailing Address - Phone:985-264-6487
Mailing Address - Fax:
Practice Address - Street 1:5855 BREMO RD STE 207
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-1922
Practice Address - Country:US
Practice Address - Phone:985-264-6487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-31
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012622432084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology