Provider Demographics
NPI:1578636502
Name:RASSOOL, MOHAMMAD (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:
Last Name:RASSOOL
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 1:665 NEWTOWN RD
Mailing Address - Street 2:SUITE 114
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:757-473-3822
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:757-473-3822
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101038190207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA187542OtherANTHEM BCBS
VA006080251Medicaid
VA32014OtherOPTIMA
VA187542OtherANTHEM BCBS