Provider Demographics
NPI:1063667608
Name:KHALID, HAMZA (MD)
Entity type:Individual
Prefix:DR
First Name:HAMZA
Middle Name:
Last Name:KHALID
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 1:2369 STAPLES MILL RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-2909
Mailing Address - Country:US
Mailing Address - Phone:804-285-8206
Mailing Address - Fax:
Practice Address - Street 1:5855 BREMO RD STE 706
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-1926
Practice Address - Country:US
Practice Address - Phone:303-776-1234
Practice Address - Fax:720-494-3107
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-24
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0060068207RG0100X
SC84983207RG0100X
VA0101268563207RG0100X
NC2015-00861207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC849835Medicaid
MNXZAXZ1243222OtherBLUECROSS BLUESHIELD OF MINNESOTA