Provider Demographics
NPI:1215122825
Name:MAHGOUB OSMAN, SAFA MOHAMED (MD)
Entity type:Individual
Prefix:DR
First Name:SAFA
Middle Name:MOHAMED
Last Name:MAHGOUB OSMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6530 HULL STREET RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23224-2636
Mailing Address - Country:US
Mailing Address - Phone:804-674-3425
Mailing Address - Fax:804-674-3437
Practice Address - Street 1:6530 HULL STREET RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23224-2636
Practice Address - Country:US
Practice Address - Phone:804-674-3425
Practice Address - Fax:804-674-3437
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-07
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101241056207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV9327691Medicare PIN