Provider Demographics
NPI:1164656401
Name:AMIRNAZMI, SOLMAZ (MD)
Entity Type:Individual
Prefix:
First Name:SOLMAZ
Middle Name:
Last Name:AMIRNAZMI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:856 J CLYDE MORRIS BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-1318
Mailing Address - Country:US
Mailing Address - Phone:757-594-4006
Mailing Address - Fax:757-534-5190
Practice Address - Street 1:12715 WARWICK BLVD
Practice Address - Street 2:SUITE O
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-1800
Practice Address - Country:US
Practice Address - Phone:757-930-0091
Practice Address - Fax:757-269-4406
Is Sole Proprietor?:No
Enumeration Date:2009-05-13
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101251690207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1164656401Medicaid
VAVV6273AMedicare PIN
VAP01080525Medicare PIN