Individual
DR. MOHAMMAD IMTIAZ MUBBASHAR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
269 MEDICAL PARK BLVD, PETERSBURG, VA 23805-9337
(804) 861-0700
Mailing address
269 MEDICAL PARK BLVD, PETERSBURG, VA 23805-9337
(804) 861-0700
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
2021-02312
NC
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
2021-02312
NC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/20/2017
Last updated
05/03/2023
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