Provider Demographics
NPI:1770553224
Name:AGBEIBOR, VICTOR H (MD)
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:H
Last Name:AGBEIBOR
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:13540 HULL STREET RD
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-2107
Mailing Address - Country:US
Mailing Address - Phone:804-739-6142
Mailing Address - Fax:804-739-8923
Practice Address - Street 1:13540 HULL STREET RD
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-2107
Practice Address - Country:US
Practice Address - Phone:804-739-6142
Practice Address - Fax:804-739-8923
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2011-07-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101246252207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC09633OtherGROUP PTAN
VAC09633OtherGROUP PTAN