Provider Demographics
NPI:1275570681
Name:ABOUHASIRA, MOHAMED MATTAR (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMED
Middle Name:MATTAR
Last Name:ABOUHASIRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:13612 HETH DR
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23114-5533
Mailing Address - Country:US
Mailing Address - Phone:804-675-5680
Mailing Address - Fax:804-675-5029
Practice Address - Street 1:1201 BROAD ROCK BLVD
Practice Address - Street 2:MCGUIRE VAMC/ PRIMARY CARE
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23249-0001
Practice Address - Country:US
Practice Address - Phone:804-675-5680
Practice Address - Fax:804-675-5029
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101235180207R00000X
CAA 83213207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine