Provider Demographics
NPI:1629016654
Name:ZIBDEH, ISAM T (MD)
Entity Type:Individual
Prefix:DR
First Name:ISAM
Middle Name:T
Last Name:ZIBDEH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:102 15TH ST NW
Mailing Address - Street 2:SUITE 301
Mailing Address - City:NORTON
Mailing Address - State:VA
Mailing Address - Zip Code:24273-1616
Mailing Address - Country:US
Mailing Address - Phone:276-679-1624
Mailing Address - Fax:276-679-6011
Practice Address - Street 1:102 15TH ST NW
Practice Address - Street 2:SUITE 301
Practice Address - City:NORTON
Practice Address - State:VA
Practice Address - Zip Code:24273-1616
Practice Address - Country:US
Practice Address - Phone:276-679-1624
Practice Address - Fax:276-679-6011
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101029808207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1629016654Medicaid
VA1629016654Medicaid
VA00X674N15Medicare PIN