Individual
KHALED A MOUSTAFA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, FAAFP
Contact information
Practice address
1770N PARHAM RD 100, RICHMOND, VA 23229-4658
(804) 615-5060
(804) 364-3520
Mailing address
1770 N PARHAM RD, 100, RICHMOND, VA 23229-4658
(804) 615-5060
(804) 364-3520
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101243031
VA
207Q00000X
Family Medicine Physician
4301080126
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0804115242
BCBS
MI
01
—
1598712390
GROUP NPI
MI
01
—
273479074
MEDICARE
VA
05
—
4774753
—
MI
05
—
4774771
—
MI
05
—
4774790
—
MI
05
—
4774806
—
MI
05
—
4774815
—
MI
Enumeration date
05/13/2006
Last updated
09/28/2015
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