Provider Demographics
NPI:1518949791
Name:MEHFOUD, GEORGE JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:JOSEPH
Last Name:MEHFOUD
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 1:1800 GLENSIDE DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-3769
Mailing Address - Country:US
Mailing Address - Phone:804-288-0399
Mailing Address - Fax:804-285-0088
Practice Address - Street 1:8923 THREE CHOPT RD
Practice Address - Street 2:STE 101
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-4660
Practice Address - Country:US
Practice Address - Phone:804-288-0057
Practice Address - Fax:804-288-0389
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101046156207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006085482Medicaid
VA1518949791Medicaid
VA110056020OtherRAILROAD MEDICARE
VA141501OtherANTHEM
VA141506OtherANTHEM
VA302011OtherANTHEM
VA141501OtherANTHEM
VA110004517Medicare PIN