Basic Information
| Provider Information | |||||||||
| NPI: | 1487606620 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | QAZIZADEH | ||||||||
| FirstName: | SALIM | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 667 KINGSBOROUGH SQ | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | CHESAPEAKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 233201677 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7578424481 | ||||||||
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| Practice Location | |||||||||
| Address1: | 300 MEDICAL PKWY STE 212 | ||||||||
| Address2: | |||||||||
| City: | CHESAPEAKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 23320 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7575470508 | ||||||||
| FaxNumber: | 7575478963 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2006 | ||||||||
| LastUpdateDate: | 09/07/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | 0101251989 | VA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | 0101251989 | 01 | VA | MEDICAL LICENSE | OTHER |