Provider Demographics
NPI:1720082183
Name:SHABAZZ, LLOYD A (MD)
Entity Type:Individual
Prefix:
First Name:LLOYD
Middle Name:A
Last Name:SHABAZZ
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 1:355 CRAWFORD ST
Mailing Address - Street 2:STE 300
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23704-2819
Mailing Address - Country:US
Mailing Address - Phone:757-396-6333
Mailing Address - Fax:757-396-6367
Practice Address - Street 1:355 CRAWFORD ST
Practice Address - Street 2:STE 300
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23704-2819
Practice Address - Country:US
Practice Address - Phone:757-396-6333
Practice Address - Fax:757-396-6367
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101058359207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA13658OtherOPTIMA HEALTH PLAN
VA261076OtherMAMSI/MDIPA
VA4493043OtherAETNA PPO/MC
VA264301OtherANTHEM BCBS
VA3600387OtherUNITED HEALTHCARE
NC7905448OtherNC MEDICAID
VA264301OtherANTHEM BCBS