Provider Demographics
NPI:1164472726
Name:ALLAUDDIN, TAHIR (MD)
Entity Type:Individual
Prefix:
First Name:TAHIR
Middle Name:
Last Name:ALLAUDDIN
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 1:601 OLD WAGNER RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23805-9313
Mailing Address - Country:US
Mailing Address - Phone:804-524-2260
Mailing Address - Fax:804-524-0096
Practice Address - Street 1:601 OLD WAGNER RD
Practice Address - Street 2:SUITE 101
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23805-9313
Practice Address - Country:US
Practice Address - Phone:804-524-2260
Practice Address - Fax:804-524-0096
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101231910207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
110234493OtherRAILROAD MEDICARE
VA5864615Medicaid
110234493OtherRAILROAD MEDICARE
VA5864615Medicaid