Provider Demographics
NPI:1780976704
Name:OZBALIK, MIHRAN (MD)
Entity type:Individual
Prefix:
First Name:MIHRAN
Middle Name:
Last Name:OZBALIK
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:PO BOX 980599
Mailing Address - Street 2:NEURO: ADULT
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23298-0599
Mailing Address - Country:US
Mailing Address - Phone:804-828-9350
Mailing Address - Fax:804-828-8965
Practice Address - Street 1:1250 E MARSHALL ST
Practice Address - Street 2:NEURO: ADULT
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298-5051
Practice Address - Country:US
Practice Address - Phone:804-828-9350
Practice Address - Fax:804-828-8965
Is Sole Proprietor?:No
Enumeration Date:2011-05-10
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program