Provider Demographics
NPI:1174533129
Name:HAMBAZ, NASSER (MD)
Entity type:Individual
Prefix:
First Name:NASSER
Middle Name:
Last Name:HAMBAZ
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 1:4876 BAXTER RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-4404
Mailing Address - Country:US
Mailing Address - Phone:757-671-7777
Mailing Address - Fax:757-671-7778
Practice Address - Street 1:4876 BAXTER RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-4404
Practice Address - Country:US
Practice Address - Phone:757-671-7777
Practice Address - Fax:757-671-7778
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101037952207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005680255Medicaid
010000357Medicare ID - Type Unspecified
VA005680255Medicaid