Provider Demographics
NPI:1013078286
Name:ZAMAN, IMTIAZ (MD)
Entity Type:Individual
Prefix:DR
First Name:IMTIAZ
Middle Name:
Last Name:ZAMAN
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:PO BOX 9886
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-0886
Mailing Address - Country:US
Mailing Address - Phone:757-436-2620
Mailing Address - Fax:757-436-3460
Practice Address - Street 1:805 RODMAN AVE
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23707-3119
Practice Address - Country:US
Practice Address - Phone:757-399-1970
Practice Address - Fax:757-436-3460
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101048628207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005846757Medicaid
VA005846757Medicaid
F45705Medicare UPIN