Provider Demographics
NPI:1467849349
Name:RIVERSIDE FAMILY MEDICINE
Entity Type:Organization
Organization Name:RIVERSIDE FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARIUM
Authorized Official - Middle Name:
Authorized Official - Last Name:MUJAHID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-314-4456
Mailing Address - Street 1:10510 JEFFERSON AVE STE A
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-3102
Mailing Address - Country:US
Mailing Address - Phone:757-594-3800
Mailing Address - Fax:575-594-3890
Practice Address - Street 1:10510 JEFFERSON AVE STE A
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23601-3102
Practice Address - Country:US
Practice Address - Phone:757-594-3800
Practice Address - Fax:575-594-3890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-19
Last Update Date:2015-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty