Provider Demographics
NPI:1912973397
Name:OKHRAVI, HAMID REZA (MD)
Entity Type:Individual
Prefix:DR
First Name:HAMID
Middle Name:REZA
Last Name:OKHRAVI
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 936
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23501-0936
Mailing Address - Country:US
Mailing Address - Phone:757-446-7040
Mailing Address - Fax:757-446-7049
Practice Address - Street 1:825 FAIRFAX AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1914
Practice Address - Country:US
Practice Address - Phone:757-446-7040
Practice Address - Fax:757-446-7049
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN37126207R00000X
VA0101240384207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1912973397Medicaid
VAPAROtherCIGNA
VA-022OtherTRICARE/CHAMPUS
VAPAROtherVIRGINIA PREMIER HEALTH
VAPAROtherMULTIPLAN
VAPAROtherUSA MANAGED CARE
VA10060155OtherOPTIMA HEALTH
VAPAROtherAETNA
NC5915059Medicaid
VAPAROtherFIRST HEALTH COMMERICAL/COVENTRY HEALTH/SOUTHERN HEALTH
VAPAROtherVIRGINIA HEALTH NETWORK
VAPAROtherUNITED HEALTHCARE/MAMSI
VA407049OtherANTHEM BC/BS
VAPAROtherCORVEL/CORCARE
TNH39744Medicare UPIN
VA10060155OtherOPTIMA HEALTH
NC5915059Medicaid