Provider Demographics
NPI:1508833591
Name:EHTESHAM, ASAD G (MD)
Entity Type:Individual
Prefix:DR
First Name:ASAD
Middle Name:G
Last Name:EHTESHAM
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 1:141 BEACON HILL PL
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24503-4127
Mailing Address - Country:US
Mailing Address - Phone:434-947-3954
Mailing Address - Fax:434-947-5944
Practice Address - Street 1:103 CLIFTON ST
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-1460
Practice Address - Country:US
Practice Address - Phone:434-947-3954
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101232833174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist