Provider Demographics
NPI:1609086362
Name:ALASKA, MUSTAFA M (MD)
Entity Type:Individual
Prefix:
First Name:MUSTAFA
Middle Name:M
Last Name:ALASKA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3241 WESTERN BRANCH BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-5260
Mailing Address - Country:US
Mailing Address - Phone:757-967-8622
Mailing Address - Fax:757-686-0541
Practice Address - Street 1:830 KEMPSVILLE RD
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-3920
Practice Address - Country:US
Practice Address - Phone:757-967-8622
Practice Address - Fax:757-686-0541
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101247975207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVAA113393Medicare PIN