Provider Demographics
NPI:1790862746
Name:MUGHAL, AMJAD IQBAL (MD)
Entity Type:Individual
Prefix:DR
First Name:AMJAD
Middle Name:IQBAL
Last Name:MUGHAL
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 1:12109 HOGANS ALY
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23836-8611
Mailing Address - Country:US
Mailing Address - Phone:804-243-2119
Mailing Address - Fax:804-530-2592
Practice Address - Street 1:12109 HOGANS ALY
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23836-8611
Practice Address - Country:US
Practice Address - Phone:804-243-2119
Practice Address - Fax:804-681-0229
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101234398207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010037786Medicaid
OH220508Medicaid
OHHO2356Medicare UPIN
VA003860E51Medicare ID - Type Unspecified
OHMU0887651Medicare ID - Type UnspecifiedFIRST MEDICARE NUMBER