Provider Demographics
NPI:1205831229
Name:AKBARI, HOMAYOON MOHAMMED (MD, PHD)
Entity Type:Individual
Prefix:
First Name:HOMAYOON
Middle Name:MOHAMMED
Last Name:AKBARI
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:436 CLAIRMONT CT STE 105
Mailing Address - Street 2:
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834-1765
Mailing Address - Country:US
Mailing Address - Phone:804-504-4671
Mailing Address - Fax:804-765-6490
Practice Address - Street 1:702 N MAIN ST
Practice Address - Street 2:
Practice Address - City:EMPORIA
Practice Address - State:VA
Practice Address - Zip Code:23847
Practice Address - Country:US
Practice Address - Phone:434-336-1222
Practice Address - Fax:434-336-1788
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101058288208600000X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
H8915Medicare UPIN
RI029003676Medicare PIN
H8915Medicare UPIN
RI9003675Medicaid