Provider Demographics
NPI:1922097310
Name:TALIBI, AZHAR A (MD)
Entity type:Individual
Prefix:DR
First Name:AZHAR
Middle Name:A
Last Name:TALIBI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7023 OLD JAHNKE RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225-4126
Mailing Address - Country:US
Mailing Address - Phone:804-320-1353
Mailing Address - Fax:804-320-6636
Practice Address - Street 1:7023 OLD JAHNKE RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225-4126
Practice Address - Country:US
Practice Address - Phone:804-320-1353
Practice Address - Fax:804-320-6636
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101231331208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA189789OtherSOUTHERN HEALTH ID
VA386295OtherANTHEM ID
VA006739008Medicaid
VA7467051OtherCIGNA ID
VA2109790OtherMAMSI ID
VA7276545OtherAETNA/US HEALTHCARE ID
VA1203029OtherUNITED HEALTHCARE ID
VA2095166OtherFIRST HEALTH ID