Provider Demographics
NPI:1326175043
Name:HAMPTON ROADS FAMILY PRACTICE
Entity Type:Organization
Organization Name:HAMPTON ROADS FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:RASSOOL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-490-1226
Mailing Address - Street 1:665 NEWTOWN RD STE 114
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-1683
Mailing Address - Country:US
Mailing Address - Phone:757-490-1226
Mailing Address - Fax:
Practice Address - Street 1:665 NEWTOWN RD STE 114
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-1683
Practice Address - Country:US
Practice Address - Phone:757-490-1226
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101038190207R00000X
VA0103300868213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010081131Medicaid
VA006080251Medicaid
VA110002120Medicare ID - Type Unspecified
VAC09168Medicare ID - Type UnspecifiedPODIATRIST MEDICARE
VAV00896Medicare UPIN
VA006080251Medicaid