Provider Demographics
NPI:1134198187
Name:ABBASI, GOHAR M (MD)
Entity type:Individual
Prefix:
First Name:GOHAR
Middle Name:M
Last Name:ABBASI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1714 E HUNDRED RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23836-3310
Mailing Address - Country:US
Mailing Address - Phone:804-530-5293
Mailing Address - Fax:804-530-5295
Practice Address - Street 1:1714 E HUNDRED RD
Practice Address - Street 2:SUITE 101
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23836-3310
Practice Address - Country:US
Practice Address - Phone:804-530-5293
Practice Address - Fax:804-530-5295
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2019-08-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101059174207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005830915Medicaid
G64264Medicare UPIN
VAVAA100864Medicare PIN