Provider Demographics
NPI:1346579638
Name:WEST END HEMATOLOGY AND MEDICAL ONCOLOGY GROUP, INC.
Entity type:Organization
Organization Name:WEST END HEMATOLOGY AND MEDICAL ONCOLOGY GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GHULAM
Authorized Official - Middle Name:DASTGIR
Authorized Official - Last Name:QURESHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-346-3182
Mailing Address - Street 1:7660 E PARHAM RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23294-4378
Mailing Address - Country:US
Mailing Address - Phone:804-346-3182
Mailing Address - Fax:804-273-1862
Practice Address - Street 1:7660 E PARHAM RD
Practice Address - Street 2:SUITE 102
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23294-4378
Practice Address - Country:US
Practice Address - Phone:804-346-3182
Practice Address - Fax:804-273-1862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-15
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101021014174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006056873Medicaid
VA006056873Medicaid