Provider Demographics
NPI:1619270568
Name:KAMAL, MADIHA MUSTAFA (MD)
Entity Type:Individual
Prefix:
First Name:MADIHA
Middle Name:MUSTAFA
Last Name:KAMAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 HEALTH PARK DR FL HP2
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-4692
Mailing Address - Country:US
Mailing Address - Phone:615-373-7600
Mailing Address - Fax:
Practice Address - Street 1:6 HICKOK ST
Practice Address - Street 2:
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-3524
Practice Address - Country:US
Practice Address - Phone:540-382-6148
Practice Address - Fax:540-382-4191
Is Sole Proprietor?:No
Enumeration Date:2010-12-15
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101253340207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1619270568Medicaid
VAP01402272Medicare PIN
VA1619270568Medicaid