Provider Demographics
NPI:1689745499
Name:HAFIZ, MAHMOODA (MD)
Entity Type:Individual
Prefix:MRS
First Name:MAHMOODA
Middle Name:
Last Name:HAFIZ
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 1:505 WASHINGTON ST
Mailing Address - Street 2:SUITE 501
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23704-3504
Mailing Address - Country:US
Mailing Address - Phone:757-393-5404
Mailing Address - Fax:757-393-5405
Practice Address - Street 1:505 WASHINGTON ST
Practice Address - Street 2:SUITE 501
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23704-3504
Practice Address - Country:US
Practice Address - Phone:757-393-5404
Practice Address - Fax:757-393-5405
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101033554251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAB05534Medicare UPIN