Provider Demographics
NPI:1245201045
Name:QURESHI, GHULAM DASTIGIR (MD)
Entity Type:Individual
Prefix:DR
First Name:GHULAM
Middle Name:DASTIGIR
Last Name:QURESHI
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 1:7202 GLEN FOREST DR
Mailing Address - Street 2:C/O VIRGINIA CANCER INSTITUTE SUITE 200
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-3781
Mailing Address - Country:US
Mailing Address - Phone:804-673-0134
Mailing Address - Fax:804-673-1796
Practice Address - Street 1:6605 W BROAD ST STE A
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-1714
Practice Address - Country:US
Practice Address - Phone:804-287-3000
Practice Address - Fax:804-673-2731
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101021014207RH0003X
VA541436644174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6056873Medicaid
VAC01120OtherGROUP PTAN
VA110001940Medicare ID - Type Unspecified
VAVVB720AMedicare PIN