Provider Demographics
NPI:1649261090
Name:SAHYOUNI, JAMAL ISKANDAR (MD)
Entity type:Individual
Prefix:DR
First Name:JAMAL
Middle Name:ISKANDAR
Last Name:SAHYOUNI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:NONE
Other - Middle Name:NONE
Other - Last Name:NONE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:6719 GOV.G.C.PERRY HWY
Mailing Address - Street 2:CLINCH VALLEY MEDICAL PLAZA SUITE 1600
Mailing Address - City:RICHLANDS
Mailing Address - State:VA
Mailing Address - Zip Code:24641-1100
Mailing Address - Country:US
Mailing Address - Phone:276-596-9510
Mailing Address - Fax:276-596-9512
Practice Address - Street 1:6719 GOV.G.C.PERRY HWY
Practice Address - Street 2:CLINCH VALLEY MEDICAL PLAZA SUITE 1600
Practice Address - City:RICHLANDS
Practice Address - State:VA
Practice Address - Zip Code:24641-1100
Practice Address - Country:US
Practice Address - Phone:276-596-9510
Practice Address - Fax:276-596-9512
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-03
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101 046869207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1073745840Medicaid
VAE88862Medicare UPIN