Provider Demographics
NPI:1215241377
Name:HAMIDI, ADAM WALI (DO)
Entity type:Individual
Prefix:DR
First Name:ADAM
Middle Name:WALI
Last Name:HAMIDI
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12713 ELLINGTON WOODS PL
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-7088
Mailing Address - Country:US
Mailing Address - Phone:301-661-1145
Mailing Address - Fax:
Practice Address - Street 1:1900 ELECTRIC RD
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-7494
Practice Address - Country:US
Practice Address - Phone:301-661-1145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-01
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH58.003539207P00000X
SC51896207PE0004X
VA0102203747207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH029100Medicare PIN