Provider Demographics
NPI:1487867958
Name:OFOGH, KAVEH (MD)
Entity Type:Individual
Prefix:DR
First Name:KAVEH
Middle Name:
Last Name:OFOGH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:301 CONCOURSE BLVD
Mailing Address - Street 2:SUITE# 210
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059
Mailing Address - Country:US
Mailing Address - Phone:804-433-1041
Mailing Address - Fax:804-433-1050
Practice Address - Street 1:301 CONCOURSE BLVD
Practice Address - Street 2:SUITE# 210
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23059
Practice Address - Country:US
Practice Address - Phone:804-433-1041
Practice Address - Fax:804-433-1050
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA01011052243207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine