Provider Demographics
NPI:1487606620
Name:QAZIZADEH, SALIM (MD)
Entity type:Individual
Prefix:
First Name:SALIM
Middle Name:
Last Name:QAZIZADEH
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 1:667 KINGSBOROUGH SQ
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-1677
Mailing Address - Country:US
Mailing Address - Phone:757-842-4481
Mailing Address - Fax:
Practice Address - Street 1:300 MEDICAL PKWY STE 212
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320
Practice Address - Country:US
Practice Address - Phone:757-547-0508
Practice Address - Fax:757-547-8963
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012519892084N0400X, 2084N0400X
PAMD4280752084N0600X, 2084S0012X, 2084V0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
No2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0101251989OtherMEDICAL LICENSE
PA100962OtherGEISINGER
PA1330942OtherAETNA - HMO
PA1017004270001Medicaid
PAQA1858304OtherHIGHMARK BLUE SHIELD
PA438890OtherHEALTH AMERICA
PA50059309OtherBLUE CROSS/CA LC
PA7832838OtherAETNA
PA1555034OtherGATEWAY
PAMD428075OtherSTATE LICENSE