Provider Demographics
NPI:1659780047
Name:EAST COAST PM&R CONSULTANTS PLLC
Entity type:Organization
Organization Name:EAST COAST PM&R CONSULTANTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:SHAHRIAR
Authorized Official - Middle Name:
Authorized Official - Last Name:NABIZADEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-803-7593
Mailing Address - Street 1:5700 FITZHUGH AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-1800
Mailing Address - Country:US
Mailing Address - Phone:904-803-7593
Mailing Address - Fax:
Practice Address - Street 1:103 NORTH ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:VA
Practice Address - Zip Code:24201
Practice Address - Country:US
Practice Address - Phone:276-642-7900
Practice Address - Fax:276-642-8092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-11
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101256648208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty