Provider Demographics
NPI:1255584876
Name:VAZQUEZ, MOHAMED (MD)
Entity type:Individual
Prefix:DR
First Name:MOHAMED
Middle Name:
Last Name:VAZQUEZ
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:DEPARTMENT OF VETERANS AFFAIRS MEDICAL CTR
Mailing Address - Street 2:100 EMANCIPATION DRIVE
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23667-0001
Mailing Address - Country:US
Mailing Address - Phone:757-728-7008
Mailing Address - Fax:757-726-6013
Practice Address - Street 1:DEPARTMENT OF VETERANS AFFAIRS MEDICAL CTR
Practice Address - Street 2:100 EMANCIPATION DRIVE
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23667-0001
Practice Address - Country:US
Practice Address - Phone:757-728-7008
Practice Address - Fax:757-726-6013
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17262208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation